Care Review Clinician (RN, LCSW, LPCC/LCPC or LMFT)

AltaStaff is a staffing agency currently looking for a Care Review Clinician I to work with our Managed Care Client!

Pay Rate: $35 - 39 hourly

Schedule: Monday-Friday, 7am-4pm CST or 8am-5pm CST

***This is a fully remote role but candidates must have RN, LCSW, LPCC/LCPC or LMFT license in IL***

Position Purpose: Care Review Clinician works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review aimed at providing members with the right care.

• Completes/reviews Inpatient Authorizations, reviewing faxes that can be 50-100 pages long

• Will be expected to manage 25-30 cases successfully daily.

• Should be able to quickly and accurately determine whether the criteria meet medical necessity.

• Provides daily review and evaluation of members that require hospitalization and/or procedures providing prior authorizations and/or concurrent review.

• Assesses services for Molina Members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and

• guidelines.

• Provides concurrent review and prior authorizations (as needed) according to Molina policy for Molina members as part of the Utilization Management team.

• Additional duties assigned

Education/Experience: 

• RN, LCSW, LPCC/LCPC or LMFT license in IL required

• Must have 2 years clinical practice experience (hospital, case management, utilization management)

• Must have 1-2 yrs Utilization Management experience; MCG experience preferred

• Experience working in acute care/medical surgical

• Area of expertise should be specific to inpatient reviews

• Must have solid experience within a clinical setting as RN’s 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.

INDLP