Care Review Clinician
- Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Healthcare members with the right care at the right place at the right time.
- Provides daily review and evaluation of members that require hospitalization and/or procedures providing prior authorizations and/or concurrent review.
- Assesses services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.
- Must be an RN
- Inpatient HOSPITAL UR: Prior Auth, Concurrent Rev. (6 months)- Identifies appropriate benefits, eligibility, and expected length of stay for members requesting treatments and/or procedures
- NCQA experience ( at least one recent year)
- Interqual or Milliman (MCG) experience
- Other basic computer skills necessary: Microsoft Office, Data Entry, etc.
- Minimum 2-4 years of clinical practice.
Hours:
Mon-Fri 8:30am-5pm
Advantages:
Competitive Pay ($33/hr. to $37/hr)
Benefits offered!
Great work environment!
Want to hear more information?
Reach out to Jeff St Louis for immediate consideration by calling 407-478-0332 ext. 223!