Medical Services Nursing Consultant - Virtual Description
Affiliated Computer Services, Inc. (ACS) is expertise in action™. We are a FORTUNE 500 company with 74,000 employees worldwide supporting client operations reaching more than 100 countries. We provide business process outsourcing and information technology solutions to world-class commercial and government clients. Our employees operate with integrity, and are flexible, reliable and responsive.
If you meet the requirements of this position and want to work for a world-class company with a great marketplace reputation, apply today.
*** This is a virtual, work from home position. Candidate may reside anywhere within the U.S.***
May perform one or more of the following:
The principal purposes of this position are to: (1) Identify significant opportunities for clinical or financial improvement in medical management, (2) Develop and design interventions that improve or maintain the quality of care while reducing the overall cost of care when possible, (3) Assist in evaluating the effectiveness of interventions, and (4) Serve as a clinical consultant for ACS and its clients.
Primary Job Responsibilities:
Assist in the development and implementation of effective integration for all medical management prior authorization (PA) activities.
o Analyze plan data to identify potential medical PA opportunities.
o Conduct baseline research using evidence-based medicine principles and collaborate with other medical management consultants to identify clinical criteria.
o Compile medical PA proposals (e.g., targeted procedure codes, approval/denial criteria, flowcharts, references, etc) for presentation to the client(s).
o Present proposals to respective client(s).
o Evaluate the delivery of services and aid in developing methods for improvement. Assist in the development and testing of new products.
o Collaborate medical PA clinical rule development with Account Implementation.
o Test and validate medical PA clinical rules.
Collaborate with IT department in development of existing and new technologies that support:
o EHR/EMR
o EPSDT
o HCBS
Review, analyze, and apply literature to specific therapeutic situations. Maintain knowledge base by participation in continuing education. Knows and is able to discuss the pathophysiology of the major disease states likely to be seen in specific client’s plans. Respond to written and oral clinical inquiries by patients, providers, or clients.
Provide marketing/sales support as needed. Assist with proposal responses. Review marketing/sales materials for clinical appropriateness. Responds to concerns identified by physicians in regard to clinical interventions.
Design and/or participate in ongoing research studies. Prepare manuscripts/abstracts for publication. Recognize and prepare case studies suitable for presentation and publication.
Education and Typical Years Experience
Nurse practitioner/physician assistant or a nurse with equivalent practice experience. Has thorough knowledge of all phases of work. Can review, analyze, and apply literature to specific therapeutic situations. Knows and can discuss medical management principles and has a working knowledge of coding (e.g., ICD-9, CPT, and HCPCS). Experience with prescribing and/or ordering services such radiology, DME, or HCBS in addition to completing EPDST forms. Word processing/spreadsheet/flowchart management software (e.g., MS Word/Excel/Visio) experience desired.
ACS is an Equal Opportunity Employer and does not Discriminate against any applicant on the basis of race, color, religion/creed, national origin, gender, or sex, marital status, age, disability, use of a guide dog or service animal, sexual orientation, military/veteran status, or any other status protected by Federal or State law or local ordinance. People with disabilities who need a reasonable accommodation to apply or compete for employment with ACS may request such accommodations by calling 866-419-2226 .
|
