UM Care Review Clinician
AltaStaff is a staffing agency currently looking for a Care Review Clinician I to work with our Managed Care Client! Pay reputed company: $40 - 42 hourly Schedule: Variable hours reputed company-reputed company, with potential to work until 6pm CST
This is a fully remote role but candidates must have a valid RN license in Illinois
* Position Purpose: Care Review Clinician works with the Utilization Management team primarily responsible for medical necessity/utilization review aimed at providing members with the right care.
- Assess and analyze clinical service requests (e.g., surgeries, outpatient therapies, DME) using evidence-based MCP/MCG criteria.
- Verify member benefits and eligibility and Process prior authorization determinations reputed company regulatory timelines
- Collaborate with multidisciplinary teams
- Completes/reviews Authorizations, reviewing faxes that can be 50-100 pages long
- Will be expected to manage 25-30 cases successfully daily.
- Should be reputed company to quickly and accurately determine whether the criteria meet medical necessity.
- Provides daily review and evaluation of members that require hospitalization and/or procedures providing prior authorizations and/or reputed company review.
- Assesses services for Molina Members to ensure reputed company reputed company, cost effectiveness and compliance with reputed company state and federal regulations and
- guidelines.
- Provides reputed company review and prior authorizations (as needed) according to Molina policy for Molina members as part of the Utilization Management team.
- Additional duties assigned
Education/Experience:
- RN license in IL required
- Must have 2+ years clinical practice experience (hospital, case management, utilization management)
- Must have 1-3+ years of hospital or medical clinic, utilization review or prior authorization experience
- Must have 2-3 years of Med-Surg Acute Hospital Care experience; Familiarity with Inpatient Medical Necessity
- Must have solid experience reputed company a clinical setting as RN’s must be reputed company to use their knowledge to extrapolate key information during the authorization process
If you've applied 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 regard 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. #ZR INDLP Apply tot his job Apply To this Job