RN NICU Specialist

RN NICU Specialist


Duties:

1. Make daily rounds with at ICN at Dameron, Saint Josephs and San Joaquin General Hospitals
2. Review cases daily with Director of Medical Management and Medical Director
3. Perform First Level Review, according to guidelines established by the Medical Director
4. Make recommendations regarding transfers, determination of level of care and discharge planning as determined by Medical Director.
5. Create PA override(s) in the DRE system.
6. Notify ICN providers of status of PA request(s)
7. Send letter(s) to members and providers for PA requests that have been modified or denied
8. Handle all ICN care related calls from providers and occasionally members
9. Troubleshoot adjudication issues, which include but not limited to rejection reason, product selection, dollar limit override, age override, injection override, refill too soon, formulary status, etc.
10. Verify eligibility and update member eligibility when needed
11. Log all patient care issues with outcomes in DRE Database
12. Initiate CCS referral process, with facilitation of chart notes and medication justification
13. Track and update all ICN CCS cases
14. Notify claims of CCS approval
15. Send letter to members notifying CCS eligibility and approval
16. Tracking Specialist referrals.
17. Develop and implement procedures for recognizing prenatal patients at high risk for preterm delivery.
18. Case Management of high risk prenatal patients.
19. Working with QI nurses in logging/tracking all referrals to QI to improve trending and reporting of QI reviews/investigations
20. Assisting clinical staff as requested
REQUIREMENTS
-Must be a RN with current and valid license in the state of California
-At least 1-2yrs experience in acute/high risk care preferably NICU or ICN
-Excellent assessment skills a ++
-Reliable transportation for daily rounds