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Care Review Clinician II Job
Eingestellt von Yoh
Gesuchte Skills: Client
Projektbeschreibung
TOP SKILLS YOU SHOULD POSSESS:
- Yoh is seeking an LVN or RN that has Interqual and Inpatient case manageent hospital experience is required. This will be a long term contract
WHAT YOU'LL BE DOING:
- Working on dual screens using 6 different systems Processing authorizations, reviewing for medical necessity and send to Medical Director If Med Director denies it, they will generate letter to send to provider -MUST be LPN -Detail oriented -Organization skills -Typing skills -Medical Office/Insurance background at least a year -Clinical background (patient care) necessary at least a year -Medicare background, Medicaid, waiver experience HUGE PLUS! weekends necessary!
- 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. Essential Functions:
- Provides concurrent review and prior authorizations (as needed) according to policy for members as part of the Utilization Management team.
WHAT YOU NEED TO BRING TO THE TABLE:
- Identifies appropriate benefits, eligibility, and expected length of stay for members requesting treatments and/or procedures.
- Participates in interdepartmental integration and collaboration to enhance the continuity of care for members including Behavioral Health and Long Term Care.
- Maintains department productivity and quality measures.
- Attends regular staff meetings. Assists with mentoring of new team members. Completes assigned work plan objectives and projects on a timely basis.
- In depth knowledge of Interqual and other references for length of stay and medical necessity determinations. Experience with NCQA.
- Ability to take initiative and see tasks to completion. Computer Literate (Microsoft Office Products).
- Excellent verbal and written communication skills.
- Preferably hospital nursing, utilization management, and/or case management. Required Licensure/Certification: Active, unrestricted State Nursing (RN, LVN, LPN) license in good standing High .
GET HIRED, APPLY NOW!
RECRUITER: Jennifer Yerkes
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Ref:
SFSF: HC
Projektdetails
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Einsatzort:
Columbus, Vereinigte Staaten
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Projektbeginn:
asap
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Projektdauer:
Keine Angabe
- Vertragsart:
-
Berufserfahrung:
Keine Angabe
Geforderte Qualifikationen
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Kategorie:
IT Entwicklung