What are the responsibilities and job description for the Care Review Clinician position at Workpath Partners?
Remote but must be located in Nevada
We are looking for a Care Review Clinician to join our growing team. You will be offered a competitive hourly rate of $42.02 / hour. We will also provide you a comprehensive benefits package.
As a Care Review Clinician you will work with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. Also work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.
Responsibilities of the Care Review Clinician:
- Assesses inpatient 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, eligibility and expected length of stay for requested treatments and/or procedures
- Conducts inpatient reviews to determine financial responsibility for members
- May also perform prior authorization reviews and/or related duties as needed
- Processes requests within required timelines
- Refers appropriate cases to Medical Directors and presents them in a consistent and efficient manner
- 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 the Care Model
- Adheres to UM policies and procedures
Job Types: Full-time, Contract, Temporary
Pay: $42.02 per hour
Schedule:
- 8 hour shift
Experience:
- Utilization Management: 2 years (Required)
- Acute Care: 2 years (Required)
- MCG: 2 years (Preferred)
License/Certification:
- RN (Required)
Location:
- Nevada (Required)
Work Location: Remote
Salary : $42
