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!