Care Review Clinician II - Syracuse, United States - AltaStaff, LLC

Description

AltaStaff is a staffing agency currently looking for a Care Review Clinician II to work with our Managed Care Client

Pay Rate: $ $45.00 hourly

Shift: 40 hours per week, 8am to 5:30pm EST

***This is a fully remote role but candidates must reside in Central or Eastern Time Zone

Summary: This role works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing members with the right care at the right place at the right time.

Responsibilities:

• Completes/reviews Inpatient Authorizations, reviewing faxes that can be pages long
• Analyzes clinical service requests from members or providers against evidence based clinical guidelines.
• Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures.
• Conducts inpatient reviews to determine financial responsibility for the client and its members. May also perform prior authorization reviews and/or related duties as needed.
• Processes requests within required timelines.
• Refers appropriate cases to Medical Directors and presents them in a consistent and efficient manner.
• 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 Care Model.
• Adheres to UM policies and procedures.

Qualifications:

• Must have active, unrestricted LPN or RN license
• Must have 2+ years clinical practice experience
• Must have 1-2+ years Utilization Management experience; MCG criteria knowledge a plus

Work Environment Requirements:

• Must be able to to lift at least 30lbs
• Must be able to stand or sit for prolonged periods (75% of the time)
• Private Secured Internet Connection
• Must confirm work environment is safe and secure for work in handling private and sensitive information.
• Constantly operates a computer and other office equipment
• Constantly works indoors in a secluded safe space
• Must have High-speed internet access 25 MBPS minimum; 50 MBPS minimum preferred

AltaStaff is an Equal Employment Opportunity Employer. We provide equal employment opportunities to all qualified applicants for employment without regard to age, race, color, creed, religion, sex, marital status, national origin, ancestry, citizenship, disability, veteran status, sexual orientation, or any other protected status, in accordance with applicable federal, state, and local laws.

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