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.
Ā **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
Ā Assesses services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.
Ā Analyzes clinical service requests from members or providers against evidence based clinical guidelines. Ā Identifies appropriate benefits and eligibility for requested treatments and/or procedures.
Ā Conducts prior authorization reviews to determine financial responsibility for our MCO client and its members.
Ā Processes requests within required timelines. Ā Refers appropriate prior authorization requests to Medical Directors.
Ā Requests additional information from members or providers in consistent and efficient manner.
Ā Makes appropriate referrals to other clinical programs. Ā Collaborates with multidisciplinary teams to promote Care Model
Ā 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 Ā 6:30 pm) through Saturday (10 am Ā 2 pm)
CRC B Ā Sunday (10 am Ā 2 pm) Monday Ā Thursday (9 am Ā 6:30 pm)
CRC C Rotates each week: Monday, Tuesday, Thursday and Friday (8:30 am Ā 5pm) Off Sundays and Wednesdays Sunday (10 am Ā 6:30 pm) Monday (8:30 am Ā 5 pm) Wednesday through Friday (8:30 am Ā 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 Now
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.
Ā **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
Ā Assesses services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.
Ā Analyzes clinical service requests from members or providers against evidence based clinical guidelines. Ā Identifies appropriate benefits and eligibility for requested treatments and/or procedures.
Ā Conducts prior authorization reviews to determine financial responsibility for our MCO client and its members.
Ā Processes requests within required timelines. Ā Refers appropriate prior authorization requests to Medical Directors.
Ā Requests additional information from members or providers in consistent and efficient manner.
Ā Makes appropriate referrals to other clinical programs. Ā Collaborates with multidisciplinary teams to promote Care Model
Ā 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 Ā 6:30 pm) through Saturday (10 am Ā 2 pm)
CRC B Ā Sunday (10 am Ā 2 pm) Monday Ā Thursday (9 am Ā 6:30 pm)
CRC C Rotates each week: Monday, Tuesday, Thursday and Friday (8:30 am Ā 5pm) Off Sundays and Wednesdays Sunday (10 am Ā 6:30 pm) Monday (8:30 am Ā 5 pm) Wednesday through Friday (8:30 am Ā 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 Now