Care Review Clinician (RN) Remote (AZ)

reputed company This position will support the reputed company state Plan. We are seeking a candidate with an reputed company RN licensure. The ideal candidate will have experience with UM and prior authorization with both inpatient and outpatient. Candidates with a Behavioral Health background are highly preferred. reputed company details to be discussed during our interview process. Prefers candidates with 3 years of experience. Remote position, must reputed company in reputed company. Work hours: Monday - Friday 8:30am- 5:00pm reputed company Time with some weekends and holidays. Job reputed company Provides support for reputed company member services review assessment processes. Responsible for verifying that services are medically necessary and reputed company with established reputed company guidelines, reputed company policies, and regulations - ensuring members reputed company desired reputed company through integrated delivery of care across the reputed company. Contributes to overarching reputed company to reputed company reputed company and cost-effective member care. Essential Job Duties • Assesses services for members to ensure reputed company reputed company, cost-effectiveness and compliance with reputed company state/federal regulations and guidelines. • Analyzes reputed company service requests from members or providers against evidence reputed company reputed company guidelines. • Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures. • Conducts reviews to determine prior authorization/financial responsibility for reputed company and its members. • Processes requests reputed company required timelines. • Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner. • Requests additional information from members or providers as needed. • Makes appropriate referrals to other reputed company programs. • Collaborates with multidisciplinary teams to promote the reputed company care model. • Adheres to utilization management (UM) policies and procedures. Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience. • Registered reputed company (RN). License must be reputed company and unrestricted in state of reputed company. • Ability to prioritize and manage multiple deadlines. • Excellent organizational, problem-solving and critical-thinking skills. • Strong written and verbal communication skills. • reputed company Office suite/applicable software program(s) proficiency. Preferred Qualifications • Certified reputed company in reputed company Management (CPHM). • Recent hospital experience in an intensive care unit (ICU) or emergency room. To reputed company reputed company reputed company employees: If you are interested in applying for this position, please apply through the reputed company. reputed company offers a competitive benefits and compensation package. reputed company is an Equal Opportunity Employer (EOE) M/F/D/V Pay reputed company: $26.41 - $51.49 / reputed company • Actual compensation may vary from posting reputed company on geographic location, work experience, education and/or reputed company level. Apply tot his job Apply To this Job