Clinical Nurse Evaluator

Paradigm Healthcare is looking to hire a skilled and motivated Central Intake Nurse to join our amazing team in Houston Texas

Reports to

Director of Referral Management

Summary/Objective

In keeping with our organization’s goals, then Clinical Nurse Evaluator will manage the clinical components of the referral process and oversees the five stages of the referral process.

Job Duties

• Utilizes Clinical Determination Tool to determine clinical acceptance.

• Oversee the denial process.
• Identifies referral care needs, high-cost medications, DME, wound care, etc.
• Understands the referral process including policy, procedures, assessments, and communication requirements.
• Participates in daily CRM calls.
• Maintain a thorough knowledge of the facilities services, clinical capabilities, and physician relationships.