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Job Requirements of Care Review Clinician I:
-
Employment Type:
Contractor
-
Location:
Fort Lauderdale, FL (Onsite)
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Care Review Clinician I
Careers Integrated Resources Inc
Fort Lauderdale, FL (Onsite)
Contractor
Job Description: Care Review Clinician:
As part of Client enterprise wide initiative leadership has requested that all candidates moving forward are sourced from the following geographical locations: Client, FL, GA, ID, IA, KY, MI, NE, NM, NY (outside greater-NYC), OH, TX, UT, WA (outside greater-Seattle), WI.
We need 2 Clinicians 1 for Prior Auths and 1 for Inpatient
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.
at least 1 year UM experience in a Client setting
LPN or RN
The ability to work remote in a high pace/high demand environment.
The ability to complete 15-20 authorization in a day
Previous experience working for Client using QNXT/UMK2 preferred
MCG Experience preferred.
Complete 15-20 authorizations per day
Review Prior auth/Inpatient/Skilled Nursing requests for medical necessity using State/Policy or MCG criteria
Please see above job description
1
RN/LPN
Hours per Week: 40 hours with Weekend Rotation
Are there time zone requirements that the resource(s) must work within (i.e., must work PST hours)? East Coast time zone or Central Time Zone
What is the typical schedule/shift going to be (i.e., 8am 5pm)? 830am-5pm or 9-6pm
As part of Client enterprise wide initiative leadership has requested that all candidates moving forward are sourced from the following geographical locations: Client, FL, GA, ID, IA, KY, MI, NE, NM, NY (outside greater-NYC), OH, TX, UT, WA (outside greater-Seattle), WI.
We need 2 Clinicians 1 for Prior Auths and 1 for Inpatient
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.
at least 1 year UM experience in a Client setting
LPN or RN
The ability to work remote in a high pace/high demand environment.
The ability to complete 15-20 authorization in a day
Previous experience working for Client using QNXT/UMK2 preferred
MCG Experience preferred.
Complete 15-20 authorizations per day
Review Prior auth/Inpatient/Skilled Nursing requests for medical necessity using State/Policy or MCG criteria
Please see above job description
1
RN/LPN
Hours per Week: 40 hours with Weekend Rotation
Are there time zone requirements that the resource(s) must work within (i.e., must work PST hours)? East Coast time zone or Central Time Zone
What is the typical schedule/shift going to be (i.e., 8am 5pm)? 830am-5pm or 9-6pm
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