Nurse Consultant

We need to produce HTML fragment with sections: headings

for each section present. We need to extract content: The posting includes sections: "Why Join Us?" with bullet points (Make a Positive Impact, Family Comes First, Professional Growth Opportunities, Dynamic Work Environment, Trust and Stability, Inclusive Work Environment). Then "Benefits & Perks" with list. Then "Job Summary" paragraph. Then "Work Location" maybe not a required heading but we could include if content present. The instruction: Use

for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule). They gave examples but we can use other headings? It says use

for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule). Likely we should map content to those standard headings where appropriate. But we can also use other headings if they match? The instruction: "use

for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule)." It suggests we should use those headings when appropriate. However we can also include other headings if they exist? It says "Include a section ONLY when the posting has real, specific content for it". So we need to decide which sections to include based on content. We have content about why join us (benefits/perks). Could map to "Benefits". Also we have "Benefits & Perks" separate list. Could combine. We have "Job Summary" -> could be "About the role" or "Responsibilities"? The job summary describes responsibilities. Could use "Responsibilities". Also we have "What you'll do" which is more detailed responsibilities. Could combine under "Responsibilities". Also we have "Education", "Experience", "Licenses and Certifications", "Travel", "Knowledge, Skills and Abilities". Those map to "Qualifications" or "Skills". Could use "Qualifications" for education/experience/licenses, and "Skills" for knowledge, skills and abilities. We have "Work Location" maybe not a standard heading but could be omitted? The instruction says we can include sections only when posting has real specific content. Work location is specific: remote/hybrid/onsite, must reside in KS/MO. Could be included under maybe "Schedule"? Not exactly. Could create a custom heading? The examples are not exhaustive; they said e.g. So we could use other headings if appropriate. But safer to stick to given examples: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. We have no Pay or Schedule info. So we omit those. Thus sections: - About the role: maybe job summary paragraph. - Responsibilities: "What you'll do" list. - Qualifications: Education, Experience, Licenses and Certifications, Travel (maybe under Requirements? but we can put under Qualifications). - Skills: Knowledge, Skills and Abilities. - Benefits: Why Join Us? + Benefits & Perks combined. We must not repeat job title as heading. No Job ID. We must preserve all substantive information. So we need to include all bullet points and details. We need to format lists with

• . For prose use

  . We must not include boilerplate like cookie/navigation/legal/EEO etc. There's none. We must not include application instructions. We must not include duplicated lines. We need to ensure we don't create sections with filler like "commensurate with experience". Not present. Let's extract content. From posting: **Why Join Us?** (with bullet points): - Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans. - Family Comes First: Total rewards package that promotes the idea of family first for all employees. Paid vacation and sick leave with paid maternity and paternity available immediately upon hire - Professional Growth Opportunities: Advance your career with ongoing training and development programs. - Dynamic Work Environment: Collaborate with a team of passionate and driven individuals in a work environment that promotes flexibility. - Trust and Stability: Work for one of the most trusted companies in Kansas with over 80 years of commitment, compassion and community. - Inclusive Work Environment: We pride ourselves on fostering a workplace where everyone is valued and respected. **Benefits & Perks**: - Base compensation is only one component of your competitive Total Rewards package - Incentive pay program (EPIP) - Health/Vision/Dental insurance - 6 weeks paid parental leave for new mothers and fathers - Fertility/Adoption assistance - 2 weeks paid caregiver leave - 401(k) plan matching up to 5% - Tuition reimbursement - Health & fitness benefits, discounts and resources **Job Summary**: This position is responsible for the day-to-day operations of reviewing and processing predeterminations, claims, appeals, and other inquiries utilizing independent decision making in accordance with medical policy, standards of medical practice, and within contractual benefits. Must be able to communicate these decisions to internal staff and to providers, members, and the Kansas Insurance Department (via CSC) as needed. The Nurse Consultant will serve as a primary resource for internal staff throughout the company regarding medical policy, correct coding, medical necessity, and other processes that relate to claims adjudication, cost effectiveness, and predeterminations. Responsible for performing all activities within state, HIPAA, DOL, InterQual, and MTM goals or guidelines. **What you'll do** (list): - Responsible for independent timely resolution of predeterminations, claims, and appeals utilizing medical policy/Interqual criteria and/or physician consultant recommendations as needed. - Responsible for responding to inquiries regarding medical necessity, correct coding, allowances, audits/CSC requests, and coding assistance requests throughout the company. - Responsible for providing clinical support for MR analysts and other internal staff as needed. - Responsible for performing all job functions within the scope of the Kansas Nurse Practice Act and maintaining professional accreditations as appropriate to the position. - Responsible for identifying potential quality of care issues and making appropriate referrals. - Assists with gathering of quality assurance/utilization management data, problem identification and analysis of data. This includes development of criteria and guidelines. - Responsible for maintaining strict HIPPA confidentiality. - Routinely provide decisions that set precedent and place the company at financial risk for shield claims and cross claims up to $500,000. - May be responsible for attending, participating in, and leading special projects and meetings. - Must follow current URAC standards as required for essential job functions. **Education**: - High school diploma or equivalent required - Bachelor's degree or equivalent in nursing preferred **Experience**: - Minimum 3 years' experience of clinical nursing experience required - RN experience in Surgical, Medical, Obstetric, and/or Utilization Management preferred **Licenses and Certifications**: - Current unrestricted Kansas RN licensure required - CPC certified or obtain certification by American Academy of Professional Coders within three years of hire required **Travel**: - No travel **Knowledge, Skills and Abilities**: - Must have a strong analytical background. - Must be self-directed with the ability to make independent decisions and prioritize personal production activities. - Must be able to maintain a productive and professional relationship with internal teams and external cross departmental and divisional (Note: The last sentence seems cut off; we keep as is.) Now we need to map to sections. About the role: Job Summary paragraph. Responsibilities: What you'll do list. Qualifications: Education, Experience, Licenses and Certifications, Travel (maybe under Requirements but we can include under Qualifications). Could also separate "Requirements" but we don't have that heading; we can use Qualifications for all. Skills: Knowledge, Skills and Abilities. Benefits: Combine Why Join Us? and Benefits & Perks. We must not create Pay or Schedule sections. Now produce HTML fragment. We'll start with

  About the role

  then

  Job summary...

  Then

  Responsibilities

  then
  • ... each bullet. Then

    Qualifications

    then maybe sub-sections? Not required; we can just list all items under
    but we might want to keep grouping. Could use
    with items for each bullet; but we have multiple categories. Could still just list all items; but we might lose grouping. However it's okay as long as we preserve all info. Could also use

    inside but not allowed? Only headings

    for section headings; we could still use

    inside? Not specified; better to avoid extra headings. We'll just use

    and list each qualification bullet. But we need to keep the distinction: Education, Experience, Licenses and Certifications, Travel. We'll just list them as separate
    • . Then

      Skills

      then
      for knowledge, skills and abilities. Then

      Benefits

      then
      for Why Join Us? and Benefits & Perks combined. Make sure we preserve all text exactly, preserving punctuation and dollar sign etc. Check for any duplicated lines: none. Now produce HTML. Be careful with escaping: The content includes apostrophes etc. It's fine as plain text. Let's craft. We'll output:

      About the role

      This position is responsible for the day-to-day operations of reviewing and processing predeterminations, claims, appeals, and other inquiries utilizing independent decision making in accordance with medical policy, standards of medical practice, and within contractual benefits. Must be able to communicate these decisions to internal staff and to providers, members, and the Kansas Insurance Department (via CSC) as needed. The Nurse Consultant will serve as a primary resource for internal staff throughout the company regarding medical policy, correct coding, medical necessity, and other processes that relate to claims adjudication, cost effectiveness, and predeterminations. Responsible for performing all activities within state, HIPAA, DOL, InterQual, and MTM goals or guidelines.

      Responsibilities

      • Responsible for independent timely resolution of predeterminations, claims, and appeals utilizing medical policy/Interqual criteria and/or physician consultant recommendations as needed.
      • Responsible for responding to inquiries regarding medical necessity, correct coding, allowances, audits/CSC requests, and coding assistance requests throughout the company.
      • Responsible for providing clinical support for MR analysts and other internal staff as needed.
      • Responsible for performing all job functions within the scope of the Kansas Nurse Practice Act and maintaining professional accreditations as appropriate to the position.
      • Responsible for identifying potential quality of care issues and making appropriate referrals.
      • Assists with gathering of quality assurance/utilization management data, problem identification and analysis of data. This includes development of criteria and guidelines.
      • Responsible for maintaining strict HIPPA confidentiality.
      • Routinely provide decisions that set precedent and place the company at financial risk for shield claims and cross claims up to $500,000.
      • May be responsible for attending, participating in, and leading special projects and meetings.
      • Must follow current URAC standards as required for essential job functions.

      Qualifications

      • High school diploma or equivalent required
      • Bachelor's degree or equivalent in nursing preferred
      • Minimum 3 years' experience of clinical nursing experience required
      • RN experience in Surgical, Medical, Obstetric, and/or Utilization Management preferred
      • Current unrestricted Kansas RN licensure required
      • CPC certified or obtain certification by American Academy of Professional Coders within three years of hire required
      • No travel

      Skills

      • Must have a strong analytical background