What are the responsibilities and job description for the Care Review Clinician II position at AltaStaff, LLC?
Job Description
Job Description
AltaStaff is a staffing agency currently looking for a Care Review Clinician II to work with our Managed Care Client!
Pay Rate : $40 - 44 hourly
Schedule : Monday -Friday 8am-5pm or 9am-6pm MST
- This is a fully remote role but candidates must have RN license in New Mexico
Position Purpose : Care Review Clinician II works 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. Works 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.
Completes / reviews Inpatient Authorizations, reviewing faxes that can be 50-100 pages long
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 the client and its 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.
Additional duties assigned
Education / Experience :
Active, unrestricted State Registered Nursing (RN) license in good standing (New Mexico)
Graduated from an Accredited School of Nursing.
Must have 3 years clinical practice experience (hospital acute care / medical experience)
Area of expertise should be specific to inpatient reviews
Must have solid experience within a clinical setting as they must be able to use their knowledge to extrapolate key information during the authorization process
AltaStaff is an Equal Employment Opportunity Employer. We provide equal employment opportunities to all qualified applicants for employment without regard to age, race, color, creed, religion, sex, marital status, national origin, ancestry, citizenship, disability, veteran status, sexual orientation, or any other protected status, in accordance with applicable federal, state, and local laws.
Salary : $40 - $44
