Clinical Nurse Evaluator

Job Details: Job Location: Paradigm Houston

• Houston, TX, Position Type: Full Time, Salary Range: Undisclosed, Job Shift: Day, Paradigm Healthcare is looking to hire a skilled and motivated Central Intake Nurse to join our amazing team in Houston Texas Reports to Director of Referral Management Summary/Objective In keeping with our organization’s goals, then Clinical Nurse Evaluator will manage the clinical components of the referral process and oversees the five stages of the referral process. Job Duties Utilizes Clinical Determination Tool to determine clinical acceptance. Oversee the denial process. Identifies referral care needs, high-cost medications, DME, wound care, etc. Understands the referral process including policy, procedures, assessments, and communication requirements. Participates in daily CRM calls. Maintain a thorough knowledge of the facilities services, clinical capabilities, and physician relationships.

Qualifications

Required Education, Experience, and Skills Must possess a current, unencumbered, active license to practice as a nurse. 2 years’ experience with admissions process at a skilled nursing facility, subacute, rehab, or other health care facility. Significant experience and strong skills using Point Click Care software. Significant experience and strong computer literacy skills (Microsoft Outlook, Microsoft Office suite, and other online platforms).

Recent long-term care experience required. Experience making independent decisions when circumstances warrant such action. Self-motivated and self-directed: possesses the ability to work independently. Excellent written and verbal communication skills. Demonstrates leadership, organizational skills, and ability to maintain a positive and professional attitude.

Ability to establish and maintain working relationships with multiple and varied people and organizations.