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Job Requirements of Care Review Clinician I | Utilization Review Nurse:
-
Employment Type:
Contractor
-
Location:
Phoenix, AZ (Onsite)
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Care Review Clinician I | Utilization Review Nurse
Careers Integrated Resources Inc
Phoenix, AZ (Onsite)
Contractor
Job Title: Care Review Clinician I | Utilization Review Nurse
Location: Phoenix, AZ (Remote)
Duration: 3 Months+ (possible to extend or TEMP TO HIRE)
Must be able to work Mon - Fri 8:30 AM TO 5:30 PM PST
Job Description:
Skills:
Required Education:
Any of the following:
Required Experience:
Preferred Experience:
Location: Phoenix, AZ (Remote)
Duration: 3 Months+ (possible to extend or TEMP TO HIRE)
Must be able to work Mon - Fri 8:30 AM TO 5:30 PM PST
Job Description:
Skills:
- 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.
Required Education:
Any of the following:
- Completion of an accredited Registered Nurse (RN) or
- 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.
- 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.
- Active, unrestricted Utilization Management Certification (CPHM).
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