Care Review Clinician II Job

CARE REVIEW CLINICIAN II needed for a CONTRACT opportunity with Yoh's client located in Troy, MI.

TOP SKILLS YOU SHOULD POSSESS:

- Managed Care Experience
- In depth knowledge of InterQual

WHAT YOU'LL BE DOING:

- Responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing members with the appropriate care
- Provide daily review and evaluation of members that require hospitalization and/or procedures providing prior authorizations and/or concurrent review
- Assess services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines
- Identify appropriate benefits, eligibility, and expected length of stay for members requesting treatments and/or procedures.
- Participate in interdepartmental integration and collaboration to enhance the continuity of care for members including Behavioral Health and Long Term Care.

WHAT YOU NEED TO BRING TO THE TABLE:

- Current Michigan RN licensed
- Two - four (2 - 4) years experience in Utilization Management and/or Case Management (preferably in clinic/hospital with UM, or Managed Care settings)
- In depth knowledge of Interqual and other references for length of stay and medical necessity determinations
- Experience with NCQA
- Strong computer skills

WHAT ARE YOU WAITING FOR? APPLY NOW!

RECRUITER: Jennifer Andersen

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SFSF: HC