Care Review Clinician I

Job Description

THIS POSITION IS A REMOTE POSITION HOWEVER MUST BE LISCENSED IN THE NEW YORK ( RN/LPN/LVN) TO BE CONSIDERED FOR THIS POSITION

Job Description:

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.

Day to Day Responsibilities:

All UM standard Inpatient, Outpatient and Custodial Care processes and workflows for any requests, verbal notifications for denials/partial denials to both member and provider, participation in IDTs, personal queue management and clinical reviews.

Job Requirement:

• Highschool Diploma or Equivalent
• Valid and unrestricted NY state RN, LVN or LPN
• 2 years' experience in Utilization Management.
• 2 years of clinical practice. Preferably hospital nursing, utilization management, and/or case management.
• 1 year of prior authorization experience
• Bi-lingual fluently speaking, reading, and writing Spanish, Bengali or Mandarin PREFERRED BUT NOT MANDATORY.
• Home office including laptop/desktop, keyboard, headset, mouse and dual monitor
  
  

For immediate consideration email Keyera with your resume to kwest@anchorstaffing.com

Company Description

See our company profile at www.anchorstaffing.com

See our company profile at www.anchorstaffing.com