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Job Requirements of Care Review Clinician I:
-
Employment Type:
Contractor
-
Location:
New York, NY (Onsite)
Do you meet the requirements for this job?
Care Review Clinician I
Careers Integrated Resources Inc
New York, NY (Onsite)
Contractor
Job Description:
Remote - NY
All UM standard/ expedited Inpatient, Outpatient and Custodial Care clinical reviews for MLTC members.
Must Have Skills:
Must have experience in UM, experience with Turnaround Timeframes, good with computer systems and be able to learn a new system, have done clinical reviews and processed denials and partial denial determinations, know MCG and can use it, case presentation for medical reviews, know Medicaid/ Medicare guidelines.
Bi-lingual in any language is preferred but not mandatory
Attendance is VERY key- please ensure that candidates do not have any Pre planned vacations during the month of December
Please ensure that candidates have experience with actually reviewing for Medicaid/ MLTC members not Medicare or IP reviews as those are very different with a different workflow and process.
Candidates must be aware that this is a fast-paced environment with a Turnaround Timeframe of 3 business days on average for our std requests 72 hours urgent/expedited requests.
Day to Day Responsibilities:
All UM standard Inpatient, Outpatient and Custodial Care processes and workflows for any requests, verbal notifications for denials/partial denials to both member and provider, participation in IDTs, personal queue management and clinical reviews, meeting expected productivity and performance Productivity expectations are set a by Client Enterprise Clinical Services based on the local Client time studied performance. Standard full capacity and performance reviews expectations is 30 cases a day there will be a 6-8 week ramp up period to full capacity post successful completion of New hire and Client specific training.
Required Years of Experience:
At least 1-2 years experience in UM.
Required Licensure / Education: Licensure required is a NY State License Practical Nurse or Registered Nurse -LPN NY & NY RN
Be sure to include the type of authorizations that were performed. All authorization types for services under the MLTC benefit Package , Medicare /Medicare/ Inpatient Skilled and facility stays . Environment supports /Modifications. /DME authorizations volumes fluctuate throughout the year with higher volumes during the last quarter of the year and January :
Any pre planned vacations must be disclosed during the interview and submission . NEO training will begin on 12/2/2024 for this role.
Comments for Suppliers: will require dual monitors and a docking station.
Please set the expectation that no days in the first 90 days shall be missed.
Remote - NY
All UM standard/ expedited Inpatient, Outpatient and Custodial Care clinical reviews for MLTC members.
Must Have Skills:
Must have experience in UM, experience with Turnaround Timeframes, good with computer systems and be able to learn a new system, have done clinical reviews and processed denials and partial denial determinations, know MCG and can use it, case presentation for medical reviews, know Medicaid/ Medicare guidelines.
Bi-lingual in any language is preferred but not mandatory
Attendance is VERY key- please ensure that candidates do not have any Pre planned vacations during the month of December
Please ensure that candidates have experience with actually reviewing for Medicaid/ MLTC members not Medicare or IP reviews as those are very different with a different workflow and process.
Candidates must be aware that this is a fast-paced environment with a Turnaround Timeframe of 3 business days on average for our std requests 72 hours urgent/expedited requests.
Day to Day Responsibilities:
All UM standard Inpatient, Outpatient and Custodial Care processes and workflows for any requests, verbal notifications for denials/partial denials to both member and provider, participation in IDTs, personal queue management and clinical reviews, meeting expected productivity and performance Productivity expectations are set a by Client Enterprise Clinical Services based on the local Client time studied performance. Standard full capacity and performance reviews expectations is 30 cases a day there will be a 6-8 week ramp up period to full capacity post successful completion of New hire and Client specific training.
Required Years of Experience:
At least 1-2 years experience in UM.
Required Licensure / Education: Licensure required is a NY State License Practical Nurse or Registered Nurse -LPN NY & NY RN
Be sure to include the type of authorizations that were performed. All authorization types for services under the MLTC benefit Package , Medicare /Medicare/ Inpatient Skilled and facility stays . Environment supports /Modifications. /DME authorizations volumes fluctuate throughout the year with higher volumes during the last quarter of the year and January :
Any pre planned vacations must be disclosed during the interview and submission . NEO training will begin on 12/2/2024 for this role.
Comments for Suppliers: will require dual monitors and a docking station.
Please set the expectation that no days in the first 90 days shall be missed.
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