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REPORTS TO:&nbsp; Manager, Utilization ManagementPOSITION DESCRIPTION:The Utilization Review Nurse acts as a liaison in the coordination of resources and services to meet patients’ needs, promotes teamwork to optimize efficient and cost-effective use of health care resources, monitors the health care delivery plan to maximize positive patient outcomes, and maintains compliance with applicable laws and regulations and the policies of Professional Health Care Network. The clinician will monitor adherence to ensure the effective and efficient use of home care-based services and monitor the appropriateness of homecare admissions, resumptions of care, reauthorizations, and extended cert periods.Primary duties include, but are not limited to:&nbsp;ESSENTIAL FUNCTIONS:·Processes patient prior and reauthorization requests as outlined by company policy.·Makes determination of the need for continued home health care services by reviewing documentation submitted by providers in accordance with Medicare guidelines.·Refers to the Utilization Review Physician Advisor cases that do not meet established guidelines for admission or continued care.·Maintains accurate records of authorizations and communication with providers and payer plans pertaining to authorization for all patients.·Assists provider staff and team members in identifying patient needs and coordinating care.·Assists provider staff and team members in efficient and cost-effective utilization of health care resources and monitors patient progress and outcomes.·Facilitates communication and provides ongoing customer service support to payer plan case managers, patients and provider staff and team members.·Prepares and submits any required status or summary reports in a timely manner.·Periodic weekend and holiday rotation and availability to address after hour health plan member needs related to home health management.·Reviews documentation and provides feedback to clinicians regarding CMS Chapter 7 and Milliman Care Guidelines to ensure accurate assessment and review data, medical records reflect compliance with medical necessity, homebound status, visit utilization supported by individual patient assessment/ documentation support and transition (discharge) planning.·Identifies problems related to the quality of patient care and refers them to the Quality Assurance Committee/QPUC.·Assists the Utilization Review Committee/QPUC in the assessment and resolution of utilization review problems.·Other duties as required and/or assigned.OFFICE LOCATION:Fully RemoteQUALIFICATIONS·Is a graduate of an accredited school of professional nursing or an accredited practical or vocational nursing program.·Has at least two years of general nursing experience in medical, surgical, or critical care, and at least one year of utilization review/management, case management or recent field experience in home health.·Is currently licensed as a registered nurse, practical nurse, or vocational nurse in good standing through the Arizona Board of Nursing and other State Boards of Nursing as applicable.·Is detail oriented and displays good organizational skills as well as good oral and written communication skills.·Excellent time management skills with a proven ability to meet deadlines.·Is self-directed, flexible, cooperative, and exhibits the ability to work with minimal supervision.·Working knowledge of home care regulatory and federal requirements.KNOWLEDGE AND EXPERIENCE:Requires knowledge in the areas of home health community-based services; utilization/case management experience is preferred. Must have a working knowledge of homecare, managed care, medical/nursing staff procedures, and community resources. NCQA and URAC knowledge is helpful. Computer skills such as MS Office products - Outlook, Excel, Word, Adobe, and the ability to work within multiple electronic medical management systems.CONTINUING EDUCATION REQUIREMENTS:Company personnel are expected to participate in appropriate continuing education as may be requested and/or required by their immediate supervisor. In addition, company personnel are expected to accept personal responsibility for other educational activities to enhance job related skills and abilities. All company personnel must attend mandatory educational programs.tango provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. tango will make reasonable accommodations for qualified individuals with known disabilities unless doing so would result in an undue hardship.

tango

Utilization Review Nurse 

SUMMARYThe Acute Registered Nurse provides acute dialysis care and treatment to patients within a hospital environment. This position performs duties as assigned by the Charge Nurse or Acute Manager, including assisting and supervising Patient Care Technicians and Licensed Vocational Nurses. Acute nurses may report directly to an Acute Manager, Administrator or the first line of regional operational management which may be an Area Director, Regional Director, or Vice President of Operations, depending on the region/demographics.Essential Duties and Responsibilities include the following. Other duties and tasks may be assigned.GROWTH· Assist with clinical and operational processes to improve patient health and minimize hospitalizations and rehospitalization.· Ensure patient and treatment charge information and other related data are accurate and submitted appropriately. · Demonstrate effective use of supplies and staff labor hours.· May participate in inventory management, including end-of-month inventory reporting and adherence to company purchasing protocols.· Perform duties as assigned to meet the patient care or operational needs.OUTCOMES· Administer medications as ordered by the physician..· Provide patient education and follow up as needed.· Assist with program's target goals in meeting quality metrics for patient outcomes in accordance with quality patient care and Company goals.OPERATIONALREADINESS· Knowledge of and comply with federal, state, local laws and regulations, including health care professionals practice act requirements.· Perform duties at all times within limitations established by and in accordance with company policy and procedures, hospital policy, applicable state and federal laws and regulations.· Complete water quality verification and equipment safety checks prior to each treatment, to include second verification as required.· Complete pre and post treatment physical assessments.· Complete pre and post Handoff Communication with hospital nurses.· Initiate and terminate patient treatments to include connecting and disconnecting catheters and cleaning catheter sites.· Set up dialysis machines; report machine problems to biomedical technician and/or Acute Manager as appropriate.· Clean, disinfect and provide quality control of dialysis machines as required by policy and procedures.· Participate in infection control monitoring, implementation, and recording as requested.· Use personal protective equipment as necessary.· Be familiar with emergency equipment and all emergency operational procedures, as required by hospital.OPERATIONALREADINESS (cont.)· Demonstrate effective staffing based on acuity, skill mix and company guidelines.· Ensure provision of dialysis related services such as Hemodialysis, Peritoneal dialysis, Continuous Renal Replacement Therapy (CRRT) and Plasmapheresis (TPE) if contracted to do so.· Participate in all surveys as required.· Ensure nursing care is carried out as directed and treatment is administered in accordance with physician orders.· Ensure appropriate and required information is documented in patient records.· Inform Supervisor, Medical Director or Physician and Hospital Liaison of all incidents, conditions, and concerns related to patient care, staff and patient safety, and in accordance with company policy.· Prepare and maintain dialysis machines and systems per policy: maintain dialysis records, prepare dialysis water treatment system for use according to established procedure and understand technical operations to troubleshoot problems independently.· Notify Bio-Medical Technician regarding machine or water treatment malfunctions, values out of parameters and document as required. PARTNERSHIPS· Communicate results of patient assessment, reassessment, and ongoing monitoring to the physician.· Maintain collaborative working relationship with physicians, nurse practitioners, and other hospital healthcare professionals.· Actively promote GUEST customer service standards; develop effective relationships at all levels of the organization.· Address patient concerns timely and professionally; following hospital policy.STAFF DEVELOPMENT/ RETENTION· Participate in staff meetings as required. Attend and complete all company and hospital required in-service and continuing education.· May delegate tasks to competent licensed and unlicensed staff per applicable state practice act.· Assist with staff training as requested.· Lead staff in team concepts and promote a team effort.

U.S. Renal Care

Dialysis Registered Nurse - St. Joseph Acutes

Arizona Kidney Disease and Hypertension Center (AKDHC) is one of the nation's largest groups of physicians specializing in the care of patients with Chronic Kidney disease. Since 1976, we have enjoyed the trust of patients and the respect of the community throughout the Phoenix Metropolitan area and across Arizona. We are a professional medical association consisting of physicians and other vital support staff. To learn more about us, please visit our website: <a href="http://www.akdhc.com.&amp;nbsp" target="_blank">www.akdhc.com.&amp;nbsp</a>;Registered Nurse (RN) - AKDHC Marana Access Surgery CenterThis RN provides pre-operative, intra-operative, and post-operative care to patients per physician’s orders. Assists during interventional and surgical operating room procedures.Essential Duties and Responsibilities:<ul><li>Prepares the patient for the medical procedure according to established guidelines.</li><li>Ensures documented informed consent has been received from the patient prior to administering sedation.</li><li>Administers medication as needed.</li><li>Administers IV therapy and other therapeutic and diagnostic measures.</li><li>Facilitates patient transfer to EMS and hospital facilities.</li><li>Expedites timely and smooth flow of patients through the Access Center.</li><li>Completes patient assessments for potential problems with patency and other indicators of dialysis access.</li><li>Maintains accurate and complete medical records.</li><li>Provides patient education and instructions on home care and documents patient’s understanding.</li><li>Uses equipment standard to the profession, such as cardiac monitors, oxygen administration systems, and stethoscopes.</li><li>Performs crash cart maintenance and defibrillator checks.</li><li>Enters pertinent information in the computer system designed for statistical analysis, research, and patient follow-up.</li><li>Maintains Infection Logbook.</li><li>Assists with maintaining adequate supply and medication inventory.</li><li>Complies with current OSHA guidelines.</li><li>Maintains the patient's right to privacy.</li><li>Participates in the Quality Assurance (QA) Program.</li></ul>Qualifications/Skills:<ul><li>Associate's degree (A. A.) or equivalent from two-year college or technical school</li><li>Two years of acute or critical care experience is preferred in addition to experience with Conscious Sedation.</li><li>Current Arizona Registered Nurse License, current certification in Basic Life Support, and current ACLS certification.</li></ul>Benefits:We value our employees’ time and efforts. Our commitment to your success is enhanced by our competitive compensation and extensive benefits package including paid time off, medical, dental and vision benefits and future growth opportunities within the company. Plus, we work to maintain the best possible environment for our employees, where people can learn and grow with the company. We strive to provide a collaborative, creative environment where each person feels encouraged to contribute to our processes, decisions, planning, and culture.We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.

Insperity

Registered Nurse - Marana Access Surgery Center

Arizona Kidney Disease and Hypertension Center (AKDHC) is one of the nation's largest groups of physicians specializing in the care of patients with renal disease. Since 1976, we have enjoyed the trust of patients and the respect of the community throughout the Phoenix Metropolitan area and across Arizona. We are a professional medical association consisting of physicians and other vital support staff. We are currently seeking an ASC Clinical Manager to join our Team. To learn more about us, please visit our website: <a href="http://www.akdhc.com" target="_blank">www.akdhc.com</a>Infection Prevention Quality Access Center NurseSummary:&nbsp;Evaluates quality of patient care and patient outcomes as they relate to healthcare-associated infections; collects, prepares and analyzes healthcare-associated infection data; presents infection data and makes recommendations for actions; monitors employee compliance in use of barriers and infection prevention measures; prepares and presents educational offerings for the staff; serves as a resource to all departments and personnel.Essential Duties and Responsibilities include the following. Other duties may be assigned.&nbsp;<ul><li>Does on-going monitoring of healthcare-associated infections.&nbsp;</li><li>Identifies infection prevention problems and makes recommendations for corrective actions.&nbsp;</li><li>Prepares the agenda for the Infection Prevention Committee.&nbsp;</li><li>Monitors infection prevention practices and employee compliance.&nbsp;</li><li>Serves as a resource for all departments and personnel.&nbsp;</li><li>Initiates, reviews, and revises infection prevention policies and procedures.&nbsp;</li><li>Conducts outbreak investigation and initiates control measures.&nbsp;</li><li>Reports communicable diseases to the state as required by law.&nbsp;</li><li>Provides educational offerings for orientation and on-going in-services.&nbsp;</li><li>Consults with department management and physicians as needed to improve care.&nbsp;</li><li>Initiates follow-up on employee/patient exposures to communicable diseases.&nbsp;</li><li>Participates in Quality Assurance (QA) program and activities.&nbsp;</li><li>Participates in short and long range planning for the infection prevention department.&nbsp;</li><li>Performs other duties as directed.&nbsp;</li><li>Complies with current OSHA guidelines.&nbsp;</li><li>Logs and PM inspections by providing support and review of logs and PM equipment and building inspections.&nbsp;</li><li>Quality Processes preparation, peer reviews, medication safety, EOC rounds, Hospitalization.&nbsp;</li><li>AAAHC, AZDHS, AORN, APIC, CMS, CDC, NHSN, ASDIN Maintain status with regulatory guidelines impacting policies and procedures of the ASC.&nbsp;</li><li>Policy and Procedures write, and rewrite policies and procedures as needed.&nbsp;</li><li>Governing Body Minutes annually and more frequently with any changes in P&amp;P.</li></ul>Supervisory Responsibilities:&nbsp;This job has no supervisory responsibilities.Competencies To perform the job successfully, an individual should demonstrate the following competencies:<ul><li>Analytical - Synthesizes complex or diverse information; Collects and researches data; Uses intuition and experience to complement data; Designs work flows and procedures.</li><li>Technical Skills - Assesses own strengths and weaknesses; Pursues training and development opportunities; Strives to continuously build knowledge and skills; Shares expertise with others.</li><li>Problem Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations; Uses reason even when dealing with emotional topics.</li><li>Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service ; Responds to requests for service and assistance; Meets commitments.</li><li>Interpersonal - Focuses on solving conflict, not blaming; Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control; Remains open to others' ideas and tries new things.</li><li>Written Communication - Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information.</li><li>Teamwork - Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed; Recognizes accomplishments of other team members.</li><li>Oral Communication - Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings.</li><li>Diversity - Demonstrates knowledge of EEO policy; Shows respect and sensitivity for cultural differences; Educates others on the value of diversity; Promotes a harassment-free environment; Builds a diverse workforce.</li><li>Ethics - Treats people with respect; Keeps commitments; Inspires the trust of others; Works with integrity and ethically; Upholds organizational values.</li><li>Organizational Support - Follows policies and procedures; Completes administrative tasks correctly and on time; Supports organization's goals and values; Benefits organization through outside activities; Supports affirmative action and respects diversity.</li><li>Strategic Thinking - Develops strategies to achieve organizational goals; Understands organization's strengths &amp; weaknesses; Analyzes market and competition; Identifies external threats and opportunities; Adapts strategy to changing conditions.</li><li>Adaptability - Adapts to changes in the work environment; Manages competing demands; Changes approach or method to best fit the situation; Able to deal with frequent change, delays, or unexpected events.</li><li>Dependability - Follows instructions, responds to management direction; Takes responsibility for own actions; Keeps commitments; Commits to long hours of work when necessary to reach goals; Completes tasks on time or notifies appropriate person with an alternate plan.</li><li>Attendance/Punctuality - Is consistently at work and on time; Ensures work responsibilities are covered when absent; Arrives at meetings and appointments on time.</li><li>Initiative - Volunteers readily; Undertakes self-development activities; Seeks increased responsibilities; Takes independent actions and calculated risks; Looks for and takes advantage of opportunities; Asks for and offers help when needed.</li><li>Motivation - Sets and achieves challenging goals; Demonstrates persistence and overcomes obstacles; Measures self against standard of excellence; Takes calculated risks to accomplish goals.</li><li>Professionalism - Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments.</li><li>Judgment - Displays willingness to make decisions; Exhibits sound and accurate judgment; Supports and explains reasoning for decisions; Includes appropriate people in decision-making process; Makes timely decisions.</li><li>Safety and Security - Observes safety and security procedures; Determines appropriate action beyond guidelines; Reports potentially unsafe conditions; Uses equipment and materials properly.</li></ul>Qualifications:&nbsp;To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions:<ul><li>Education/Experience: Associate's degree (A. A.) or equivalent from two-year college or technical school. Experience in Quality Assessment Performance Improvement (QAPI), and Fire and Safety Programs.</li><li>Language Ability:&nbsp;Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization.</li><li>Math Ability:&nbsp;Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.</li><li>Reasoning Ability: Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.</li><li>Computer Skills: To perform this job successfully, an individual should have some basic computer knowledge.</li><li>Certificates and Licenses:&nbsp;Current Arizona Registered Nurse License, current certification in Basic Life Support and current ACLS certification.</li></ul>Work Environment:&nbsp;The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this Job, the employee is regularly exposed to risk of radiation. The noise level in the work environment is usually moderate.Physical Demands:&nbsp;The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The employee must regularly lift and /or move up to 50 pounds. While performing the duties of this job, the employee is regularly required to stand; walk; sit; use hands to finger, handle, or feel; reach with hands and arms; climb or balance; stoop, kneel, crouch, or crawl and talk or hear.Key Qualifications:&nbsp;<ul><li>Registered Nurse (RN) with an active license&nbsp;</li><li>Minimum of 5 years of experience in healthcare quality management and reporting.&nbsp;</li><li>Strong understanding of quality measures.&nbsp;</li><li>Excellent analytical, organizational, and communication skills.&nbsp;</li><li>Experience with electronic health records systems.&nbsp;</li><li>Ability to travel up to 50%</li></ul>Benefits:We value our employees’ time and efforts. Our commitment to your success is enhanced by our competitive compensation and extensive benefits package including paid time off, medical, dental and vision benefits, and future growth opportunities within the company. Plus, we work to maintain the best possible environment for our employees, where people can learn and grow with the company. We strive to provide a collaborative, creative environment where each person feels encouraged to contribute to our processes, decisions, planning, and culture.We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.

Infection Prevention Quality Access Center Nurse

Arizona Kidney Disease and Hypertension Center (AKDHC) is one of the nation's largest groups of physicians specializing in the care of patients with Chronic Kidney disease. Since 1976, we have enjoyed the trust of patients and the respect of the community throughout the Phoenix Metropolitan area and across Arizona. We are a professional medical association consisting of physicians and other vital support staff. To learn more about us, please visit our website: <a href="http://www.akdhc.com" target="_blank">www.akdhc.com</a>.Registered Nurse (RN) - AKDHC Phoenix Access Surgery CenterThis RN provides pre-operative, intra-operative, and post-operative care to patients per physician’s orders. Assists during interventional and surgical operating room procedures.Essential Duties and Responsibilities:<ul><li>Prepares the patient for the medical procedure according to established guidelines.</li><li>Ensures documented informed consent has been received from the patient prior to administering sedation.&nbsp;</li><li>Administers medication as needed.&nbsp;</li><li>Administers IV therapy and other therapeutic and diagnostic measures.&nbsp;</li><li>Facilitates patient transfer to EMS and hospital facilities.&nbsp;</li><li>Expedites timely and smooth flow of patients through the Access Center.&nbsp;</li><li>Completes patient assessments for potential problems with patency and other indicators of dialysis access.&nbsp;</li><li>Maintains accurate and complete medical records.&nbsp;</li><li>Provides patient education and instructions on home care and documents patient’s understanding.&nbsp;</li><li>Uses equipment standard to the profession, such as cardiac monitors, oxygen administration systems, and stethoscopes.&nbsp;</li><li>Performs crash cart maintenance and defibrillator checks.&nbsp;</li><li>Enters pertinent information in the computer system designed for statistical analysis, research, and patient follow-up.&nbsp;</li><li>Maintains Infection Logbook.&nbsp;</li><li>Assists with maintaining adequate supply and medication inventory.&nbsp;</li><li>Complies with current OSHA guidelines.&nbsp;</li><li>Maintains the patient's right to privacy.&nbsp;</li><li>Participates in the Quality Assurance (QA) Program.</li></ul>Qualifications/Skills:<ul><li>Associate's degree (A. A.) or equivalent from two-year college or technical school&nbsp;</li><li>Two years of acute or critical care experience is preferred in addition to experience with Conscious Sedation.&nbsp;</li><li>Current Arizona Registered Nurse License, current certification in Basic Life Support, and current ACLS certification.</li></ul>Benefits:We value our employees’ time and efforts. Our commitment to your success is enhanced by our competitive compensation and extensive benefits package including paid time off, medical, dental and vision benefits and future growth opportunities within the company. Plus, we work to maintain the best possible environment for our employees, where people can learn and grow with the company. We strive to provide a collaborative, creative environment where each person feels encouraged to contribute to our processes, decisions, planning, and culture.We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.

5 Nursing Jobs in Arizona