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    care review clinician i - , NY, United States - AltaStaff, LLC

    AltaStaff, LLC
    AltaStaff, LLC , NY, United States

    3 weeks ago

    Default job background
    Description
    AltaStaff is a staffing agency currently looking for a Care Review Clinician I to work with our Managed Care Client

    Pay Rate: $ $39.00 hourly

    Shift: Monday - Friday, 8 hour shifts

    ***This is a fully remote role but candidates must be licensed in NY***

    Summary: This role will review provider service requests for applicable medical necessity and processing results. Will assesses inpatient services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines. Works to ensure patient 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.

    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.
    • Occasional travel to other offices or hospitals as requested, may be required. This can vary based on the individual State Plan.
    POSITION QUALIFICATIONS
    • Must have active, unrestricted NY State LPN or RN license
    • Bilingual in Spanish, Bengali or Mandarin is preferred
    • Must have 2+ years clinical MLTC 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.

    #RNCM1
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