Managed Care (RN,LPN, non-clinical positions)

Strategic Health Development Corporation is a Managed Care Company. We have been in operation for over 20 years, in all markets across the USA and abroad. We work in a pleasant and supportive professional atmosphere in Miami Shores, FL. We are located close to the southern area of Broward County and easily accessible from I-95 in Miami-Dade.
REQUIREMENTS
Utilization Management Department

We are hiring for the following positions in our Utilization Management Department:

Intake Coordinator
- Responsible for handling all incoming calls to the Utilization Management Department. Supports Utilization Management process of intakes.
- Uses a script to provide review of DME, Physical Therapy and other appropriate services.
- Typing & computer skills a must. Knowledge of medical terminology, CPT's and ICD-9 codes required.

LPN/RN, Clinical Reviewer
- Reviews requests for authorization for hospital admissions, outpatient services, home health care, therapies, etc. using established criteria and own clinical expertise to determine medical necessity, cost-effectiveness and appropriateness of setting.
- Knowledge of Interquall Millaman Criteria required. Typing and computer skills a must.

Case Management Department

We are hiring for the following position in our Case Management Department:

Registered Nurse, Case Manager
- Utilizing a cooperative process the Case Manager will assess, plan, implement, monitor and evaluate the options and services required to meet an individual's health needs, using communications and available resources to promote quality cost-effective outcomes.
- The Case Manager helps identify appropriate providers and facilities throughout the continuum of services while ensuring that available resources are being used in a timely cost-effective manner in order to obtain optimum value for both the client and the reimbursement source. CCM preferred.
- Impeccable language, excellent written communication and computer skills a must. The ability to speak Spanish is also required for the Registered Nurse, Case Manager.
- We do telephonic case management. Familiarity with pre certification and other Utilization Management activities a plus.