Care Review Clinician

 In

Website Administrative

Reference Code: 5270

Care Review Clinician

Location: Long Beach, CA 90802
Job Type: Contract with possible extension
Pay rate: $30.00/hr

 

Summary: 

  • Works with the Utilization Management team primarily 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. 
  • 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. 
  • Provides concurrent review and prior authorizations (as needed) according to company policy for members as part of the Utilization Management team.
  • Identifies appropriate benefits, eligibility, and expected length of stay for members requesting treatments and/or pro mentoring of new team members
  • Maintains professional relationships with provider community and internal and external customers. Conducts self in a professional manner at all times. Maintains cooperative and effective workplace relationships and adheres to company Code of Conduct. 
  • Consults with and refers cases to medical directors regularly, as necessary.
  • Complies with required workplace safety standards. 
  •  Demonstrated ability to communicate, problem solve, and work effectively with people.  
  • Excellent organizational skill with the ability to manage multiple priorities. 
  • Work independently and handle multiple projects simultaneously.  
  • Knowledge of applicable state, and federal regulations. 
  • 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.
  • Ability to abide by company policies. 
  • Ability to maintain attendance to support required quality and quantity of work.
  • Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA). 
  • Skilled at establishing and maintaining positive and effective work relationships with coworkers, clients, members, providers and customers.

Required Experience:
Minimum 0-2 years of clinical practice.
Preferably hospital nursing, utilization management, and/or case management. 

Required Licensure/Certification:
Active, unrestricted State Nursing (RN) license in good standing.

For more information, please call our Recruiter directly at (847)380-7282. To submit your application, click on the 'Apply for Job' link below or send your resume directly to Alyssa.Coronel@bluestonestaffing.com.

blueStone Staffing recruits top talent for some of the most desired companies on a contract, contract-to-hire and direct hire basis. We take pride in presenting our candidates with great opportunities that they may not have exposure to elsewhere. By working with blueStone, you'll have access to rewarding opportunities, competitive compensation, and industry leading benefits packages. We look forward to helping you land your next career opportunity and achieving your goals!

 

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