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Decypher is a leading integrator of professional, technology, and management solutions and services. We provide our services globally to Federal, Commercial, Local and State clients. Our employees are our most valuable asset and play an integral role in the success of Decypher and our clients. Working at Decypher is not a job, but a career where your talent and energy is respected, and you can personally make a difference. Decypher invites you to join our professional team. Decypher is an equal opportunity/affirmative action employer committed to diversifying its workforce (M/F/D/V).
DESCRIPTION
Decypher is seeking a Registered Nurse Case Manager/CAMO with heavy focus on Traumatic Brain Injury.
RESPONSIBILITIES
- Develops and implements a comprehensive Utilization Management plan/program.
- Performs data/metrics collection on identified program areas; analyzes and trends results, including over- and underutilization of healthcare resources.
- Analyzes medical referrals/appointments and general hospital procedures and regulations by monitoring specialty care referrals for appropriateness, covered benefits, and authorized surgery/medical procedures, laboratory, radiology and pharmacy.
- Reviews previous and present medical care practices for patterns; trends incidents of under-or over-utilization of resources incidental to providing medical care.
- Acts as referral approval authority for designated referrals per local/AF/DoD/national guidance and standards.
QUALIFICATIONS
- Bachelor's Degree in Nursing (BSN).
- Registered Nurse License.
- Possess a minimum of two years of inpatient medical-surgical experience or acute rehabilitation within the last three years.
- Possess one of the following certifications or obtain within 6 months of performance start date:
- Commission for Case Manager Certification Certified Case Manager (CCM).
- Certification of Disability Management Specialists Commission: Certified Disability Management Specialist (CDMS).
- Association of Rehabilitation Nurses: Certified Rehabilitation Registered Nurse (CRRN).
- American Board for Occupational Health Nurses Certified Occupational Health Nurse (COHN) or Certified Occupational Health Nurse-Specialist (COHN-S).
- National Board for Certification in Continuity of Care: Advanced Certification in Continuity of Care (ACCC).
- Commission on Rehabilitation Counselor Certification: Certified Rehabilitation Counselor (CRC).
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