$57k–$62k/yr
Utilization Review Registered Nurse
Hines and Associates · Centralia, WA
Job description
Nurses - are you looking for a change? Want to work no nights, no weekends, and no holidays? Check out Hines & Associates! *Must have Mental Health and/or Substance Abuse experience* ABOUT US: Hines is a nationwide, independentleader in personalized managed health care, focused on what's important to you-comprehensive services with the program excellence and cost containment that you demand. Hines & Associates, Inc.'s reputation as an industry leader is founded on over three decades of innovative and professional healthcare excellence. Serving all aspects of the industry, Hines is committed to conserving health care dollars while ensuring quality care through effective programs and personalized service. WHAT WE OFFER: • Competitive salary and benefits, including medical, dental, vision, long-term care, short-term disability, long-term disability, company paid and voluntary life insurance. Critical Illness, accident insurance and flexible spending also available! • 401k plan with company match, fully vested after 1 year. • No weekends and nights! • Paid Holidays • Work-life balance. • Remote setting ROLE DESCRIPTION: This individual will utilize clinical knowledge and communication skills to obtain patient specific information regarding patient condition and proposed treatments and procedures to determine if illness and/or proposed services meet acceptable criteria sets and acceptable nursing practice guidelines for outpatient treatment or inpatient confinement. This individual will certify treatment for confinement when criteria and/or practice guidelines are met, in accordance with the health benefit plan, disability, workers compensation regulations and state and federal regulations. If these conditions do not appear to be met, this individual will defer decision to a second level reviewer. This individual interfaces with case managers and disease management nurses on active cases involved in other Hines' programs. *****This is a Monday through Friday position, 9:30 AM to 6:00 PM.****** RESPONSIBILITIES AND PERFORMANCE: • Completes first level reviews within the scope of practice relevant to the clinical area(s) addressed in the initial clinical review. General Medical-Surgical nursing is sufficient to be relevant to the clinical areas addressed in most initial clinical reviews. . • Demonstrates ability to assess a patient's current medical status, including complications and untoward events, which may require additional intervention. Provides certification of medical, disability and workers compensation cases. • Demonstrates a thorough understanding of criteria sets and their limitations including when a second level review is required. • Evaluates appropriateness of current plan of care. • Assesses aftercare needs, implements discharge planning and/or case management referral in a timely manner. • Maintains knowledge of current advances and trends in medical care. • Demonstrates knowledge of URAC guidelines, Hines policies and procedures, and standards of practice and their revisions. Able to attain and maintain the minimal quality assurance performance standards. • Demonstrates assertiveness in completion of precertification and concurrent review within the guidelines of URAC, disability, workers compensation regulations, and state and federal requirements and according to the Hines policies and procedures. • Performs onsite evaluations as needed or requested. • Additional responsibilities as assigned. PM21 COMMUNICATION: • Communicates with hospital staff, physicians, other providers and Hines customer contacts in a competent, calm, effective and professional manner. • Effectively communicates the need to refer to a higher-level review for questionable plans of treatment. • Provides written documentation concerning the clinical information obtained regarding the patient's status, benefit and claim concerns, and validation of criteria. • Communicates knowledge of policies and procedures, URAC guidelines, disability and workers compensation regulations, state and federal requirements, and standards of practice. PERSONAL AND PROFESSIONAL: • Participates in self-evaluation by identifying areas of strength and limitations and offers and accepts constructive criticism. • Creative and assertive. • All First Level Reviewers are required to sign and honor a confidentiality statement at the time of hire and annually at the time of performance reviews. Requirements QUALIFICATIONS: • Registered Nurse with valid, unrestricted, current nursing license in the state or territory of the United States where employed. For mental health/substance abuse, licensed medical professional with an unrestricted license in the state or in a state that has licensure reciprocation with the state of the office location the employee is working in may perform first level reviews. Accepted licensure includes but is not limited to RN, LMSW, LMHC. • Must have Mental Health or Substance Abuse experience. • Successful completion of UR nurse orientation program. • Minimum of 3 years recent acute clinical practice required, 5 years preferred. • Managed care, disability or workers compensation experience helpful but not mandatory. • Customer service oriented. *Hines welcomes diversity and as an equal opportunity employer all qualified applicants will be considered regardless of race, religion, color, national origin, sex, age, sexual orientation, gender identity, disability or protected veteran status.* Salary Description $57,244 - $62,180 per year
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Now Hiring CDL-A Truck Drivers! Apply today and within 24 hours you'll receive multiple job offers. Earn $.60 - $.80+ CPM and up per year based on position. Simply select the driving job that offers you what is most important. Higher pay, increased benefits or more home-time: You choose. Avg. Company Driver Job Offers Salary: $85,000-$110,000+ Avg. Owner Operator Job Offers Salary: $200,000-$325,000+ Apply now to receive your job offers!
Licensed Psychiatric Nurse Practitioner
Headway · Centralia, WA
" Licensed Psychiatric Nurse Practitioner Wage: Up to $206.36/hour Did you know that you can build a flexible private practice on your terms as a psychiatric nurse practitioner? Whether you want to see patients alongside a full-time job or grow a full-time practice, Headway makes it easy to accept insurance, boost your earnings, and focus on care - without the administrative burden. It's all on one free-to-use platform, no commitment required. About the role This position is for licensed psychiatric nurse practitioners looking to start or grow their private practice. Headway provides the tools, resources, and support to help you navigate insurance, streamline operations, and let you focus on what matters most - your patients. About you • You're a fully licensed psychiatric nurse practitioner with your DEA or CDS number, ANCC or AANP board certification, a valid NPI number and malpractice insurance. • You're looking to start or expand your private practice while maintaining control over your schedule, client load, and work environment. Why partner with Headway? As an independent provider with Headway, you'll gain access to: • Hassle-free insurance credentialing: Get credentialed for free in multiple states within as little as 30 days. • Increased earnings: Secure competitive rates with top insurance plans through our nationwide network. • Predictable bi-weekly payments: Receive reliable payouts directly from Headway. • Built-in EHR tools: Access real-time scheduling, secure client messaging, documentation templates, assessments, and more. • Compliance & audit support: Stay up-to-date with insurance requirements and industry regulations. • Free continuing education: Earn CEUs and expand your expertise through Headway Academy. How Headway supports your patients • Increased access: Headway makes it easier for your clients to get the care they need at a price they can afford through insurance. • Instant verification: Clients can easily check their insurance status and get the care they need without disruption. Important Notes • This is a 1099 independent contractor role. You'll have full autonomy over your practice, including setting your hours and managing your caseload. • At this time, Headway can't support mental health professionals that aren't fully licensed. If your application was rejected for incomplete licensure, you're welcome to reapply once you have a valid license. About Headway We make it easy for mental health providers to take insurance by credentialing you with the nation's largest networks, handling billing and admin paperwork, and helping you earn more stable income with higher rates. With Headway, you can finally focus on what matters most: providing life-changing care. We'll take care of the rest.
Customer Service Advocate, Level I
Ampcus · Centralia, WA
Ampcus Inc. is a certified global provider of a broad range of Technology and Business consulting services. We are in search of a highly motivated candidate to join our talented Team. Job Title: Customer Service Advocate, Level I. Location: Baltimore, MD. Job Description: Purpose: • Responsible for answering members, provider & broker inquiries pertaining to product information, benefits, claims resolution, eligibility and billing questions in a call center environment. • Proactively provides information and education to members, providers & brokers, as appropriate, about a variety of health, financial, and self-service programs. Provides basic technical assistance and troubleshooting guidance for digital and electronic applications. Essential Functions: • 45% Provides first-level problem resolution to member, provider & broker inquiries via telephone by gathering and researching information; examine claim submissions verifying claim and system accuracy as well as liability, validate customer understanding of information and resolves issues based on applicable policies and procedures. • 25% Uses knowledge of products and the contractual provisions that govern administration to provide customer service and education, to interpret contractual language to the customer for the purpose of providing benefit utilization and limitations, to determine the need for managed care initiatives, and to administer all types of services to customers within the business segment through telephonic inquiries, written and/or electronic inquiries and claims adjustments, if applicable. Appropriately documents all client interactions according to established departmental procedures. • 15% Delivers accurate information to customers in accordance with performance goals and objectives. • 10% Maintains customer records by updating account information by effectively utilizing the business areas enrollment/inquiry tracking system & processes. • 5% Participates in ongoing education related to new services, industry topics, and skills. Qualifications: • 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 accommodation may be made to enable individuals with disabilities to perform the essential functions. Preferred Qualifications: Knowledge, Skills and Abilities (KSAs): • Successful completion of the training provided., Proficient. • Demonstrated skills as an empathetic and compassionate communicator., Proficient. • Ability to quickly gain customer trust and confidence., Proficient. • Demonstrated PC navigation and data entry skills., Proficient. • Strong interpersonal communication skills., Proficient. • Good oral and written communication skills., Proficient. Top 5 Required Skills: • Strong Communication Skills: • Clear verbal and written communication is essential for explaining complex Medicare benefits and resolving member concerns. • Associates must be able to simplify jargon, speak with empathy, and maintain professionalism across diverse populations. • Technical Proficiency: • Comfort with CRM systems, call center software, and Medicare databases is vital. • Associates should be able to navigate multiple systems simultaneously, enter data quickly, and troubleshoot basic tech issues. • Emotional Intelligence and Patience: • Medicare members may be elderly, frustrated, or confused. Associates need active listening skills, patience, and the ability to stay calm under pressure. • Building trust and rapport is key to member satisfaction and retention. • Attention to Detail: • Call center reps must accurately document member interactions, verify personal and plan information, and follow compliance protocols. • Mistakes can lead to coverage issues or HIPAA violations, so precision is non-negotiable. • Knowledge of Medicare Guidelines: • A solid understanding of Medicare Parts A, B, C, and D, eligibility, enrollment periods, and coverage rules is critical. • Associates often handle policy-specific questions, so familiarity with CMS regulations and plan structures helps ensure accurate support. Education Level: • High School Diploma or GED. Experience: • Less than one year's customer service experience. Ampcus is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veterans or individuals with disabilities.
LTSS Nursing Facility Service Coordinator Level 1*
Harris Health System · Centralia, WA
Job Summary Responsible for performing telephonic or face-to-face clinical assessments for the identification, evaluation, coordination, and management of member's needs, including physical health, behavioral health, social services and long-term services and supports. Identifies membersfor high-risk complications and coordinates care in conjunction with the member and the health care team. Manages members with chronic illnesses, co-morbidities, and/or disabilities, to insure cost effective and efficient utilization of health benefits. Obtains a thorough and accurate member history to develop an individual care plan. Establishes short- and long-term goals in collaboration with the member, caregivers, family, natural supports, physicians; identifies members that would benefit from an alternative level of care or other waiver programs. The RN has overall responsibility to develop the care plan for services for the member and ensures the member's access to those services. May assist with the implementation of member care plans by facilitating authorizations/referrals for utilization of services, as appropriate, within benefits structure or through extra-contractual arrangements, as permissible. Interfaces with Medical Directors, Physician Advisors and/or Inter-Disciplinary Teams on the development of care management treatment plans. May also assist in problem solving with providers, claims or service issues. Directs and/or supervises the work of any LPN/LVN, LSW, LCSW, LMSW, and other licensed professionals other than an RN, in coordinating services for the member by, for example, assigning appropriate tasks to the non-RN clinicians, verifying and interpreting member information obtained by these individuals, conducting additional assessments, as necessary, to develop, monitor, evaluate, and revise the member's care plan to meet the member's needs, and reviewing and providing input on the non-RN clinicians' performance on a regular basis. Assists in meeting member needs by referring members to internal and external resources. Provide follow up with internal and external resources, providers, and state programs. Coordinate with and participate in ICT meetings with Nursing Facility Staff, member, Responsible Party, treating physicians, therapists, and any other applicable parties. Coordinate and assist with the transition to the community through the Money Follows the Person (MFP) process for any member who indicates a desire to leave the nursing facility. Marginal Functions Provide input and/or data to direct supervisor/manager related to any internal or external mandatory audit or reporting. Serve as mentor, subject matter expert or preceptor to new staff. Involved in process improvement initiatives. Assist in problem solving with providers, claims or service issues. Community Health Choice's Core Competencies • Customer Focus • Reliability and Dependability • Honest and Integrity • Change Management • Teamwork • Impact/Influence + Strategic Vision • People/Team Development Minimum Qualifications Education/Specialized Training/Licensure: Requires a current unrestricted RN license in Texas, Graduate of an accredited school of nursing. Bachelors degree in nursing preferred. CCM Work Experience (Years and Area): 3-4 years of experience in working with individuals with chronic illnesses, co-morbidities, and/or disabilities in a Service Coordinator, Case Management, or similar role; or any combination of education and experience, which would provide an equivalent background. 1 year experience working with population who receive waiver services,1 year experience working with persons with disabilities/chronic conditions and Long-Term Services & Supports. Management Experience (Years and Area): N/A Software Proficiencies: Microsoft Office, Clinical documentation platforms, Internet Other: Local travel required. Reliable transportation with valid driver's license with good driving record