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Job Requirements of Care Review Clinician I:
-
Employment Type:
Contractor
-
Location:
Phoenix, AZ (Onsite)
Do you meet the requirements for this job?
Care Review Clinician I
Careers Integrated Resources Inc
Phoenix, AZ (Onsite)
Contractor
Job Title: Care Review Clinician I
Duration: 3 Months (possible to extend or TEMP TO HIRE)
Location: Remote
Job Description:
Must be able to work M-F 8:30AM TO 5:30PM PST
TEMP TO HIRE
KNOWLEDGE/SKILLS/ABILITIES:
• Assesses services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.
• Analyzes clinical service requests from members or providers aProductst evidence based clinical guidelines.
• Identifies appropriate benefits and eligibility for requested treatments and/or procedures.
• Conducts prior authorization reviews to determine financial responsibility for *** and its members.
• Processes requests within required timelines.
• Refers appropriate prior authorization requests to Medical Directors.
• 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 Client Care Model
• Adheres to UM policies and procedures.
• Occasional travel to other Client offices or hospitals as requested, may be required. This can vary based on the individual State Plan.
JOB QUALIFICATIONS:
Required Education:
Any of the following:
Completion of an accredited Registered Nurse (RN), Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) Program OR a bachelor’s or master’s degree in a healthcare field, such as social work or clinical counselor (for Behavioral Health Care Review Clinicians only).
Required Experience:
1-3 years of hospital or medical clinic experience.
Required License, Certification, Association
Active, unrestricted State Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) license in good standing .
Must be able to travel within applicable state or locality with reliable transportation as required for internal meetings.
Preferred Experience:
3-5 years clinical practice with managed care, hospital nursing or utilization management experience.
Preferred License, Certification, Association
Active, unrestricted Utilization Management Certification (CPHM).
Comments for Suppliers:
Duration: 3 Months (possible to extend or TEMP TO HIRE)
Location: Remote
Job Description:
Must be able to work M-F 8:30AM TO 5:30PM PST
TEMP TO HIRE
KNOWLEDGE/SKILLS/ABILITIES:
• Assesses services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.
• Analyzes clinical service requests from members or providers aProductst evidence based clinical guidelines.
• Identifies appropriate benefits and eligibility for requested treatments and/or procedures.
• Conducts prior authorization reviews to determine financial responsibility for *** and its members.
• Processes requests within required timelines.
• Refers appropriate prior authorization requests to Medical Directors.
• 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 Client Care Model
• Adheres to UM policies and procedures.
• Occasional travel to other Client offices or hospitals as requested, may be required. This can vary based on the individual State Plan.
JOB QUALIFICATIONS:
Required Education:
Any of the following:
Completion of an accredited Registered Nurse (RN), Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) Program OR a bachelor’s or master’s degree in a healthcare field, such as social work or clinical counselor (for Behavioral Health Care Review Clinicians only).
Required Experience:
1-3 years of hospital or medical clinic experience.
Required License, Certification, Association
Active, unrestricted State Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) license in good standing .
Must be able to travel within applicable state or locality with reliable transportation as required for internal meetings.
Preferred Experience:
3-5 years clinical practice with managed care, hospital nursing or utilization management experience.
Preferred License, Certification, Association
Active, unrestricted Utilization Management Certification (CPHM).
Comments for Suppliers:
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