The Nurse Planner works autonomously to develop any and/or all of the following: Life Care Plans, Medical Cost Projections, Limited Medical Cost Projections, Medicare Set-Aside Allocations, Legal Nurse Reviews, Complex Nurse Reviews, Bill Reviews and other reports as needed within their scope of licensing and certifications.
ESSENTIAL DUTIES AND RESPONSIBILITIES TO PERFORM THIS JOB SUCCESSFULLY INCLUDE, BUT ARE NOT LIMITED TO THE FOLLOWING:
Collects, reviews and analyzes health data from medical records and/or other sources as provided.
Identify future medical needs utilizing medical standards of care and guidelines, in addition to historical trend of care.
Work autonomously and collaborates with all company personnel as needed; including communicating with the accounts and attorneys as needed.
Maintain a quality work product evidenced by acceptable quality scores/score cards.
Participate in company orientation, management meetings and/or conference calls as required to improve self-knowledge and/or for the improvement of the company.
Attend all scheduled conference calls as mandated by management.
Maintain any required credentials and adhere to all codes of ethics required by these credentials.
Ensures all federal Centers for Medicare and Medicaid Services (CMS) requirements and/or state mandates are adhered to at all times.
Provides insight and direction to management on report quality and compliance with all company policies and procedures, client specifications, URAC and CMS guidelines.
Promote effective and efficient utilization of company resources.
Participate in various educational and or training activities as required.
Perform professional duties as assigned by the Manager or upper management.