Remote Care Review Clinician/Utilization RN/LPN - Various States
Remote Review Clinician: Payrate: $38.00 - $42.00 Seeking 2 RN/LPN from one of the following geographical locations: AZ, FL, GA, ID, IA, KY, MI, NE, NM, NY (outside greater-NYC), OH, TX, UT, WA (outside greater-Seattle), WI.
COMPACT LICENSE IS PREFERRED
** Must have at least 1 year UM experience in a HP setting LPN or RN and the ability to work remote in a high pace/high demand environment. Must work either EST or CST hours PLEASE REVIEW THE SCHEDULE OPTIONS BELOW We need 2 Clinicians, 1 for Prior Authorizations and 1 for Inpatient KNOWLEDGE/SKILLS/ABILITIES Assesses services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines. Analyzes clinical service requests from members or providers against evidence based clinical guidelines. Identifies appropriate benefits and eligibility for requested treatments and/or procedures. Conducts prior authorization reviews to determine financial responsibility for our MCO client and its members. Processes requests within required timelines. Refers appropriate prior authorization requests to Medical Directors. 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. The ability to complete 15-20 authorization in a day Previous experience working for using QNXT/UMK2 preferred MCG Experience preferred. Review Prior auth/Inpatient/Skilled Nursing requests for medical necessity using State/Policy or MCG criteria Hours per Week: 40 hours with Weekend Rotation Schedule Options: CRC A - Tuesday (9 am 6:30 pm) through Saturday (10 am 2 pm) CRC B Sunday (10 am 2 pm) Monday Thursday (9 am 6:30 pm) CRC C Rotates each week: Monday, Tuesday, Thursday and Friday (8:30 am 5pm) Off Sundays and Wednesdays Sunday (10 am 6:30 pm) Monday (8:30 am 5 pm) Wednesday through Friday (8:30 am 5 pm) Off Tuesdays and Saturdays For immediate consideration: Kimberly Cameron, PHR [email protected] 773-881-5743 Company DescriptionSee our company profile at www.anchorstaffing.com Also on LinkedIn: https://www.linkedin.com/company/anchorstaffing-inc Apply Job!