Care Review Clinician Job

CARE REVIEW CLINICIAN needed for a CONTRACT opportunity with Yoh's client located in MIAMI, FL.

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 right care at the right place at the right time
- 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 Florida RN or LPN license
- At least one solid year experience in Utilization Management or Review (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 QNXT
- Experience with NCQA

WHAT ARE YOU WAITING FOR? APPLY NOW!

RECRUITER: Jennifer Andersen

Yoh, a Day & Zimmermann company, is an Equal Opportunity Employer, M/F/D/V. Contact us if you are an individual with a disability and require accommodation in the application process.

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