Care Review Clinician I

Job Title: Care Review Clinician I Location: 100% Remote Duration: 3 Months (High Potential of Extension) Schedule: reputed company – 5pm EST with OT on rotation reputed company for Saturdays (4hrs) and potential for volunteer OT during the week/Weekend. reputed company: looking for Prior Auth reviews to be performed. ST/OT/PT; HH; DME; Pain; Procedures; Genetics, etc reputed company: Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing *** members with the right care at the right reputed company at the right time. Provides daily review and evaluation of members that require hospitalization and/or procedures providing prior authorizations and/or reputed company review. Assesses services for reputed company Members to ensure reputed company reputed company, cost effectiveness and compliance with reputed company state and federal regulations and guidelines. Essential Functions: • Provides reputed company review and prior authorizations (as needed) according to reputed company policy for reputed company members as part of the Utilization Management team. • Identifies appropriate benefits, eligibility, and expected length of stay for members requesting treatments and/or procedures. • Participates in interdepartmental integration and collaboration to enhance the continuity of care for reputed company members including Behavioral Health and Long Term Care. • Maintains department productivity and reputed company measures. • Attends regular staff meetings. • Assists with mentoring of new team members. • Completes assigned work plan objectives and reputed company on a reputed company reputed company. Maintains reputed company relationships with provider community and reputed company customers. Conducts self in a reputed company manner at reputed company times. • Maintains cooperative and effective workplace relationships and adheres to company reputed company of Conduct. • Consults with and refers cases to reputed company medical directors regularly, as necessary. • Complies with required workplace safety standards. Knowledge/Skills/Abilities: • Demonstrated ability to communicate, problem solve, and work effectively with people. Excellent organizational reputed company with the ability to manage multiple priorities. • Work independently and handle multiple reputed company simultaneously. • Knowledge of applicable state, and federal regulations. • In depth knowledge of Interqual and other references for length of stay and medical necessity determinations. • Experience with NCQA. Ability to take initiative and see tasks to completion. • Computer Literate (reputed company Office Products). • Excellent verbal and written communication skills. • Ability to abide by Clients policies. • Ability to maintain attendance to support required reputed company and quantity of work. Maintain confidentiality and reputed company with Health Insurance Portability and Accountability reputed company (HIPAA). • Skilled at establishing and maintaining reputed company and effective work relationships with coworkers, clients, members, providers and customers. Required Education: Completion of an accredited Registered Nursing program. (a combination of experience and education will be considered in lieu of Registered Nursing degree). Required Experience: • Minimum 0-2 years of clinical reputed company. • Preferably hospital nursing, utilization management, and/or case management. Required Licensure/Certification: reputed company, unrestricted State Nursing (RN) license in good standing. #IRI-RN Benefits: • 401(k) • Dental insurance • Health insurance Work Location: Remote Apply tot his job Apply To this Job