Care Review Clinician I - Atlanta - Careers Integrated Resources Inc

    Careers Integrated Resources Inc
    Careers Integrated Resources Inc Atlanta

    1 week ago

    Description

    Job Title: Care Review Clinician I

    Below covers everything you need to know about what this opportunity entails, as well as what is expected from applicants.

    Location: Remote

    Duration: 2-3 Months+ (Possible Extension)

    Pay Rate: $37.97/hr. on W2

    Job Description:

    · Client Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including medical-surgical adult and pediatric members .

    · HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

    Knowledge/Skills/Abilities:

    · Assesses inpatient 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, eligibility and expected length of stay for requested treatments and/or procedures.

    · Conducts inpatient reviews to determine financial responsibility for Client Healthcare 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 providers in a consistent and efficient manner.

    · Makes appropriate referrals to other clinical programs, such as Case Management.

    · Collaborates with multidisciplinary teams to promote Client Care Model.

    · Adheres to UM policies and procedures.

    · Flexibility.Dependability,Reliability,Good time Management, Organized.

    · Attention to detail – especially important for both reviews being completed but also to ensure HIPAA compliance when communicating determinations and other information with facilities

    · Ability to multi-task, focus and work in a fast-paced environment

    · Ability to work efficiently to ensure meeting strict deadlines per our state requirements/contract

    · Proficient in the use of Microsoft Office applications

    · Ability to work with multiple monitors and in multiple applications to complete reviews

    · Highly Recommended, but not required: Familiarity with medical necessity criteria (i.e. MCG criteria)

    · Review clinical received from facilities for Client members who have been admitted for inpatient medical. xhuatnn

    · Collaborate with & outreach facilities to ensure authorization information is up to date and clinical information and discharge information are received in a timely manner

    · Refers appropriate Inpatient Medical requests to Medical Directors for medical necessity reviews.

    · Collaborate with multidisciplinary team members (i.e. Case Management) to ensure member needs are being addressed

    · Attend weekly team meetings

    · Monthly 1:1s with supervisor

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