What are the responsibilities and job description for the Care Review Clinician I position at Careers Integrated Resources Inc?
Remote for Albuquerque
Update per HM- It could be up to 40 hours, if a CRC is on PTO, likely less hours than that week to week.
Some weekend coverage, as well, which I am still defining.
For now- please discuss PT work with your candidates to see if there is any interest.
If there is no interest to work PT hours please withdraw your candidates within the next hour.
I will re-open to allow additional submissions for candidates who are interested in PT hours.
Will the position be 100% remote? Yes
Are there any specific location requirements? No, but helpful to be in NM and understand NM nuances for UM
Are there are time zone requirements? The only requirement would be for the person to be available 8 5 MST, M-F.
What are the must have requirements? 3 5 years UM experience, preferably in behavioral health and physical health, but if only physical health, that is fine.
What are the day to day responsibilities? Reviewing clinical for medical necessity of physical/behavioral admissions, or procedures.
Is there specific licensure is required in order to qualify for the role? LPN, RN
What is the desired work hours (i.e. 8am 5pm) 8 5 M-F, some weekends
Summary: Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing *** 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 Client Members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines. Essential Functions: Provides concurrent review and prior authorizations (as needed) according to Client policy for Client members as part of the Utilization Management team. Identifies appropriate benefits, eligibility, and expected length of stay for members requesting treatments and/or procedures. Participates in interdepartmental integration and collaboration to enhance the continuity of care for Client members including Behavioral Health and Long Term Care. Maintains department productivity and quality measures. Attends regular staff meetings. Assists with mentoring of new team members. Completes assigned work plan objectives and projects on a timely basis. Maintains professional relationships with provider community and internal and external customers. Conducts self in a professional manner at all times. Maintains cooperative and effective workplace relationships and adheres to company Code of Conduct. Consults with and refers cases to Client medical directors regularly, as necessary. Complies with required workplace safety standards. Knowledge/Skills/Abilities: Demonstrated ability to communicate, problem solve, and work effectively with people. Excellent organizational skill with the ability to manage multiple priorities. Work independently and handle multiple projects simultaneously. Knowledge of applicable state, and federal regulations. In depth knowledge of Interqual and other references for length of stay and medical necessity determinations. Experience with NCQA. Ability to take initiative and see tasks to completion. Computer Literate (Microsoft Office Products). Excellent verbal and written communication skills. Ability to abide by Clients policies. Ability to maintain attendance to support required quality and quantity of work. Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA). Skilled at establishing and maintaining positive and effective work relationships with coworkers, clients, members, providers and customers. Required Education: Completion of an accredited Registered Nursing program. (a combination of experience and education will be considered in lieu of Registered Nursing degree). 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, LVN, LPN) license in good standing.
Comments for Suppliers: will require 1 monitor
Update per HM- It could be up to 40 hours, if a CRC is on PTO, likely less hours than that week to week.
Some weekend coverage, as well, which I am still defining.
For now- please discuss PT work with your candidates to see if there is any interest.
If there is no interest to work PT hours please withdraw your candidates within the next hour.
I will re-open to allow additional submissions for candidates who are interested in PT hours.
Will the position be 100% remote? Yes
Are there any specific location requirements? No, but helpful to be in NM and understand NM nuances for UM
Are there are time zone requirements? The only requirement would be for the person to be available 8 5 MST, M-F.
What are the must have requirements? 3 5 years UM experience, preferably in behavioral health and physical health, but if only physical health, that is fine.
What are the day to day responsibilities? Reviewing clinical for medical necessity of physical/behavioral admissions, or procedures.
Is there specific licensure is required in order to qualify for the role? LPN, RN
What is the desired work hours (i.e. 8am 5pm) 8 5 M-F, some weekends
Summary: Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing *** 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 Client Members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines. Essential Functions: Provides concurrent review and prior authorizations (as needed) according to Client policy for Client members as part of the Utilization Management team. Identifies appropriate benefits, eligibility, and expected length of stay for members requesting treatments and/or procedures. Participates in interdepartmental integration and collaboration to enhance the continuity of care for Client members including Behavioral Health and Long Term Care. Maintains department productivity and quality measures. Attends regular staff meetings. Assists with mentoring of new team members. Completes assigned work plan objectives and projects on a timely basis. Maintains professional relationships with provider community and internal and external customers. Conducts self in a professional manner at all times. Maintains cooperative and effective workplace relationships and adheres to company Code of Conduct. Consults with and refers cases to Client medical directors regularly, as necessary. Complies with required workplace safety standards. Knowledge/Skills/Abilities: Demonstrated ability to communicate, problem solve, and work effectively with people. Excellent organizational skill with the ability to manage multiple priorities. Work independently and handle multiple projects simultaneously. Knowledge of applicable state, and federal regulations. In depth knowledge of Interqual and other references for length of stay and medical necessity determinations. Experience with NCQA. Ability to take initiative and see tasks to completion. Computer Literate (Microsoft Office Products). Excellent verbal and written communication skills. Ability to abide by Clients policies. Ability to maintain attendance to support required quality and quantity of work. Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA). Skilled at establishing and maintaining positive and effective work relationships with coworkers, clients, members, providers and customers. Required Education: Completion of an accredited Registered Nursing program. (a combination of experience and education will be considered in lieu of Registered Nursing degree). 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, LVN, LPN) license in good standing.
Comments for Suppliers: will require 1 monitor
