US
0 suggestions are available, use up and down arrow to navigate them
PROCESSING APPLICATION
Hold tight! We’re comparing your resume to the job requirements…
ARE YOU SURE YOU WANT TO APPLY TO THIS JOB?
Based on your Resume, it doesn't look like you meet the requirements from the employer. You can still apply if you think you’re a fit.
Job Requirements of Care Review Clinician I:
-
Employment Type:
Contractor
-
Location:
Rome, WI (Onsite)
Do you meet the requirements for this job?
Care Review Clinician I
Careers Integrated Resources Inc
Rome, WI (Onsite)
Contractor
Job Description:
90-120 day assignment
hours will range from 32-40/week
must work CST timezone hours; start time is 8am
must be licensed in Wisconsin
will need dual monitors & a docking station
Job Summary
Completes clinical reviews for inpatient services. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care.
Must Have Skills:
Registered Nurse (RN). License must be active and unrestricted in state of Wisconsin
Ability to prioritize and manage multiple deadlines.
Excellent organizational, problem-solving and critical-thinking skills.
Strong written and verbal communication skills.
Microsoft Office suite/applicable software program(s) proficiency.
Knowledge of nationally recognized criteria, MCG preferred. InterQual acceptable.
UM/UR experience
Preferred Qualifications:
Certified Professional in Healthcare Management (CPHM).
Recent hospital experience in an intensive care unit (ICU) or emergency room.
UM/UR experience
Health Plan UM experience
Essential Job Duties
Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines.
Analyzes clinical service requests from members or providers aProductst evidence based clinical guidelines.
Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures.
Conducts reviews to determine prior authorization/financial responsibility for Client and its members.
Processes requests within required timelines.
Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner.
Requests additional information from members or providers as needed.
Makes appropriate referrals to other clinical programs.
Attends Rounds
Collaborates with multidisciplinary teams to promote the Client care model.
Adheres to utilization management (UM) policies and procedures.
At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience.
Registered Nurse (RN). License must be active and unrestricted in state of Wisconsin
90-120 day assignment
hours will range from 32-40/week
must work CST timezone hours; start time is 8am
must be licensed in Wisconsin
will need dual monitors & a docking station
Job Summary
Completes clinical reviews for inpatient services. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care.
Must Have Skills:
Registered Nurse (RN). License must be active and unrestricted in state of Wisconsin
Ability to prioritize and manage multiple deadlines.
Excellent organizational, problem-solving and critical-thinking skills.
Strong written and verbal communication skills.
Microsoft Office suite/applicable software program(s) proficiency.
Knowledge of nationally recognized criteria, MCG preferred. InterQual acceptable.
UM/UR experience
Preferred Qualifications:
Certified Professional in Healthcare Management (CPHM).
Recent hospital experience in an intensive care unit (ICU) or emergency room.
UM/UR experience
Health Plan UM experience
Essential Job Duties
Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines.
Analyzes clinical service requests from members or providers aProductst evidence based clinical guidelines.
Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures.
Conducts reviews to determine prior authorization/financial responsibility for Client and its members.
Processes requests within required timelines.
Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner.
Requests additional information from members or providers as needed.
Makes appropriate referrals to other clinical programs.
Attends Rounds
Collaborates with multidisciplinary teams to promote the Client care model.
Adheres to utilization management (UM) policies and procedures.
At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience.
Registered Nurse (RN). License must be active and unrestricted in state of Wisconsin
Get job alerts by email.
Sign up now!
Join Our Talent Network!