RN or LSW Care Review Clinician I

AltaStaff is a reputed company agency currently looking for a Care Review Clinician I to work with our Managed Care reputed company! Pay reputed company: $35 - $39 reputed company Available Schedules: M-F 8:30am-5pm EDT, M-F 9am-5:30pm EDT, or 9:30am-6pm EDT (weekend work needed as reputed company if candidates want to work a reputed company schedule) • **This is a fully remote role but candidates must have be a RN or LSW in Kentucky*** reputed company: This role will review provider service requests for applicable medical necessity and processing results. Will assesses outpatient services for members to ensure reputed company reputed company, cost effectiveness and compliance with reputed company state and federal regulations and guidelines. Works to ensure patient reputed company toward desired reputed company with reputed company care that is medically appropriate and cost-effective based on the severity of illness and the site of service. Responsibilities: • Completes/reviews Outpatient Authorizations, reviewing faxes that can be 50-100 pages long • Analyzes clinical service requests from members or providers against evidence based clinical guidelines. • Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures. • Conducts outpatient reviews to determine financial responsibility for the reputed company and its members. May also reputed company prior authorization reviews and/or reputed company duties as needed. • Processes requests reputed company required timelines. • Refers appropriate cases to Medical Directors and presents them in a consistent and efficient manner. • Requests additional information from members or providers in consistent and efficient manner. • Makes appropriate referrals to other clinical programs. • Collaborates with multidisciplinary teams to promote Care Model. • Adheres to UM policies and procedures. POSITION QUALIFICATIONS • Must have RN license or LSW license in Kentucky • Must have 2+ years of clinical reputed company experience (behavioral health, hospital, case management, utilization management) • Must have 1-2+ years Utilization Management experience • Experience with behavioral health highly preferred • Must have experience working in a high production reputed company Work Environment Requirements: • Must be reputed company to to lift at least 30lbs • Must be reputed company to stand or sit for prolonged periods (75% of the time) • Private Secured Internet reputed company • Must confirm work environment is reputed company and secure for work in handling private and sensitive information. • Constantly operates a computer and other office equipment • Constantly works indoors in a secluded reputed company reputed company • Must have High-speed internet reputed company 25 MBPS minimum; 50 MBPS minimum preferred If you've reputed company and would like to view your application status, please visit: https://altastaff.zenople.com/login/reputed company AltaStaff is an Equal Employment Opportunity Employer. We reputed company equal employment opportunities to reputed company reputed company applicants for employment without reputed company to age, race, reputed company, creed, religion, sex, marital status, national reputed company, reputed company, citizenship, disability, veteran status, sexual orientation, or any other protected status, in accordance with applicable federal, state, and local laws. #RNCM1 #ZR Apply Job! Apply to this Job