Position Summary:

Ensures the continuation of medically necessary services to our patients post -acute care. Demonstrates understanding of post-acute services and case management as it relates to the continuum of care.

Essential Job Functions, Duties, and Responsibilities:

•  Demonstrates the ability to understand CMS and Commercial Insurance requirements to ensure compliance with regulations and standards.

•  Must be knowledgeable of medical necessity review guidelines for commercial, Medicare, and Medicaid insurance products. 

•  Uses knowledge of insurance criteria and regulations in order to expedite appropriate use of resources and compliance with third party payer contracts.

•  Demonstrates the ability to communicate effectively via phone and email with our internal and external customers.

•  Strong organization and ability to multi task is essential to success in this role.

Qualifications

Licensure, Certification, Experience and Education Requirements:

•  BSN preferred

•  Currently licensed Registered Nurse in the state of GA.

•  A minimum of 3-years of clinical experience is required. 

•  Home Health Care and or skilled nursing industry experience highly preferred.

•  RN Case Management experience preferred.

•  Must be proficient in the use of computer applications for daily use. 

•  Highly proficient in Microsoft Word, Intermediate Excel and Outlook required

Family Makes Us Stronger. Our family, your family, one family. Committed to loving, giving, and caring. United in making a difference.

We are eager to connect with you! Apply Now to get started at PruittHealth!

As an Equal Employment Opportunity employer, all qualified applicants will receive consideration without regard to race, color, religion, sex, national origin, disability, or veteran status.