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Care Review Clinician

Location : Chicago, Il
Job Type : Contract
Reference Code : 17896
Hours : Full Time
Travel : No
Relocation : No
Job Industry : Healthcare - Health Services
Job Category : Healthcare - RNs & Nurse Management

Job Description :

We are looking for RN Care Review Clinicians . These positions are 100% remote so you can reside anywhere in the US. Must have an active, unrestricted license to qualify for these positions. These are full time remote positions 8a-5p CST. Some holidays and weekends are required.




Job Duties: 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.

Must Have Experience: : Experience working in a hospital setting – surgical or outpatient. Their area of expertise should be specific to prior authorizations experience, and must have solid experience within a clinical setting as they will need to be able to use their knowledge to extrapolate key information during the prior authorization process.

DAY-TO-DAY: Prior Authorizations, reviewing faxes that can be 30-50 pages long. Will be expected to manage 15-20 PAs successfully daily. Should be able to quickly and accurately determine whether the criteria meets medical necessity. Previous experience a must.


 


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 immediate consideration please email sroper@mednationalstaffing.com.


Required Qualifications :
 
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