Care Review Clinician

Job Tittle:
Healthcare - Care Review Clinician I

Location:
Remote

Duration: 3+ Months

Pay Range: $40.06 - $43.06

Job Description:

• Identifies appropriate benefits, eligibility, and expected length of stay
• Participates in interdepartmental integration and collaboration to enhance continuity of care, including Behavioral Health and Long Term Care
• Maintains department productivity and quality measures
• Attends regular staff meetings
• Assists with mentoring of new team members
• Completes assigned work plan objectives and projects on a timely basis
• Maintains professional relationships with provider community and internal and external customers
• Conducts self in a professional manner at all times
• Maintains cooperative and effective workplace relationships and adheres to the company Code of Conduct
• Consults with and refers cases to medical directors as necessary
• Complies with required workplace safety standards
• Knowledge / Skills / Abilities
• Demonstrated ability to communicate, problem solve, and work effectively with people
• Excellent organizational skills with the ability to manage multiple priorities
• Ability to work independently and handle multiple projects simultaneously
• Knowledge of applicable state and federal regulations
• In-depth knowledge of Inter Qual and other references for length of stay and medical necessity determination
• Experience with NCQA
• Ability to take initiative and see tasks through to completion
• Computer literate with Microsoft Office products
• Excellent verbal and written communication skills
• Ability to abide by Client policies
• Ability to maintain attendance to support required quality and quantity of work
• Maintains confidentiality and complies with HIPAA
• Skilled in establishing and maintaining effective work relationships with coworkers, clients, members, providers, and customers.

• Completion of an accredited Registered Nursing program
• A combination of education and experience may be considered in lieu of a Registered Nursing degree

• Minimum 0–2 years of clinical practice
• Preferred experience in hospital nursing, utilization management, and/or case management
• Required Licensure / Certification
• Active, unrestricted State Nursing license (RN, LVN, LPN) in good standing
• MCG experience required
• Managed Care experience required
• Minimum of 2 years MCO experience required