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Lead Mediation/Appeals Nurse
Job#: 179101
Positions: 1
Posted: 03/11/2013
Job Type: Full Time
Location: Raleigh, NC (NC-IA)
Department: NC-IA
Category: Administrative Assistant
Salary: Salary
Benefits: Full Benefits
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Job Description

Liberty Healthcare Corporation of North Carolina is seeking a Nurse administrator to serve as Lead Mediation/Appeal Nurse.

This position supports Liberty’s initiative to advance a statewide program in North Carolina that will administer in-home nursing assessments to individuals for the purpose of determining “needs-based" eligibility.

This position will have responsibility for representing the organization in mediations and appeals brought by service recipients. S/he communicates directives and educational information from the Director of Assessments and other senior management staff to the Mediation/Appeal Nurses.

This full-time position will be based in Raleigh, North Carolina.

Primary Duties and Responsibilities:

  • Conducts mediations at the request of recipients, who have had services denied, terminated, or reduced;
  • Seeks to negotiate settlements prior to mediation hearings;
  • Participates in mediations via telephone;
  • Upon hire, begins analysis for improvement of Mediation and Appeals process, including development of database for tracking/trending all decisions, dates, issues and outcomes and providing automated monthly report;
  • Learns and maintains appropriate systems to comply with and implement applicable policies and procedures;
  • Manages mediation records and reports using a database that is developed by Liberty’s database subcontractor, which will track all mediation/appeal requests, dates of the requests, number of requests completed and not completed, and outcomes;
  • Identifies and documents specific quality indicators for monitoring and tracking the reasons for adverse appeal decisions;
  • Develops a monthly report on quality indicators and adverse appeal decisions to Director of Assessment and the six Regional Nurse Assessment Managers for the purposes of trend analysis and continuous quality improvement, including the refinement of quality improvement measures in the assessments and inter-rater reliability levels of the Nurse Assessors;
  • Assists the Director of Quality Data and Reporting in developing and refining the database for tracking information regarding all mediations and appeals;
  • Assesses plans and directs resources and initiatives to consistently promote the goals of the project, protect public resources, and fulfill the program’s stated mission and vision and objectives – within the budget and with high customer satisfaction;
  • Assures contract compliance by delivering quality services and meeting all contractual, legal and regulatory requirements pertaining to his/her role;
  • Proactively anticipates and prevents problems that could result in customer dissatisfaction or failure to deliver contracted services;
  • Responsible to recognize risk and implement plans to control and avoid such risk;
  • Performs other duties as assigned.

Hiring the preeminent candidates, investing in their continued success, and rewarding their ongoing contribution are at the core of our belief system. Liberty is proud to offer a competitive compensation and benefits package.

Click here for a detailed overview of the benefits package offered to full-time employees of Liberty Healthcare Corporation of North Carolina
http://www.libertyhealthcare.com/upload/302.pdf

Skills/Requirements
  • Master’s degree in Nursing or a related field; Bachelor’s degree in Nursing.  Additional experience may substitute for some education;
  • A North Carolina license as a RN and extensive experience in the assessment and treatment of disabled populations in home care (PCS) or home health settings;
  • Previous experience with due process proceedings;
  • Computer literacy and ability to utilize computer to fill spreadsheets, documents and reports;
  • Possesses very strong interpersonal and communication skills;
  • Strong orientation to customer service;
  • Must be able to manage ambiguity and work in fast paced environment;
  • Ability to organize and manage multiple priorities.

Liberty Healthcare Corporation is a leading provider of advanced treatment delivery systems for the public and private sectors in community and facility settings. Certified by The Joint Commission for our healthcare staffing program, our organization has achieved its leadership position by an unwavering commitment to our mission of providing healthcare management solutions of the highest quality that are customer-focused, cost-effective, gainful, and outcomes oriented. We’re looking for people who embrace our mission and core values, take pride in their profession, have a passion for excellence, and a drive for results. If you’re looking for a challenging opportunity, where you can make a real difference, we’re looking for you!

Liberty Healthcare Corporation is doing business in North Carolina as Liberty Healthcare Corporation of North Carolina.

Liberty Healthcare Corporation of North Carolina is an Equal Opportunity Employer.

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