Demo
Salary Resume Critique Job Openings

Care Review Clinician

Med National Staffing Inc.
Albuquerque, NM Full Time
POSTED ON 3/7/2025
AVAILABLE BEFORE 6/8/2025

Job Description

Job Description

Contract Care Review Clinician (Inpatient Review) – New Mexico (Remote)

Pay Rate : $45.99 per hour

Location : Remote (Must be based in New Mexico)

Schedule : Monday - Friday, 8 : 00 AM - 5 : 00 PM or 9 : 00 AM - 6 : 00 PM

Our client is seeking experienced healthcare professionals to join their team in New Mexico as Care Review Clinicians, specializing in Utilization Management and Prior Authorization Reviews for inpatient and behavioral health services.

Available Positions :

  • Care Review Clinician, Inpatient Review
  • Care Review Clinician, Inpatient Review (Behavioral Health)

Confidentiality Notice :

The client’s name will not be disclosed until an interview is scheduled.

Care Review Clinician, Inpatient Review

Responsibilities :

  • Review prior authorization requests for inpatient services for New Mexico Medicaid.
  • Conduct medical necessity reviews and process member and provider benefit determination notices.
  • Assess inpatient services to ensure compliance with state and federal regulations.
  • Refer complex cases to Medical Directors when necessary.
  • Collaborate with multidisciplinary teams to improve patient outcomes.

    • Qualifications :

  • Education : Graduate from an Accredited School of Nursing (BSN preferred).
  • Experience : Minimum of three years of acute care / hospital experience (ICU, Medical, ER preferred).
  • Licensure : Active, unrestricted RN license in New Mexico (Compact license preferred).
  • Technical Skills : Proficiency in Microsoft Teams, Outlook, and Word; experience in Utilization Review or Home Health.
  • Equipment Required : Laptop, keyboard, mouse, headset, and two monitors.

    • Care Review Clinician, Inpatient Review (Behavioral Health)

    Responsibilities :

  • Conduct medical necessity reviews for inpatient behavioral health authorizations for New Mexico Medicaid members.
  • Ensure compliance with evidence-based clinical guidelines and Medicaid regulations.
  • Refer cases to Medical Directors and make appropriate referrals to other clinical programs.
  • Collaborate with multidisciplinary teams to optimize care coordination.

    • Requirements

    Care Review Clinician, Inpatient Review

    Qualifications :

  • Education : Graduate from an Accredited School of Nursing (BSN preferred).
  • Experience : Minimum of three years of acute care / hospital experience (ICU, Medical, ER preferred).
  • Licensure : Active, unrestricted RN license in New Mexico (Compact license preferred).
  • Technical Skills : Proficiency in Microsoft Teams, Outlook, and Word; experience in Utilization Review or Home Health.
  • Equipment Required : Laptop, keyboard, mouse, headset, and two monitors.

    • Care Review Clinician, Inpatient Review (Behavioral Health)

    Qualifications :

  • Education : Master’s Degree in Social Work, Psychology, or other Behavioral Health field (BSN preferred).
  • Experience : Behavioral health hospital experience in ICU, Medical, or ER preferred.
  • Licensure : Active, unrestricted RN license in New Mexico (Compact license preferred) OR Licensed Clinical Social Worker (LCSW).
  • Technical Skills : Proficiency in Microsoft Teams, Outlook, and Word; experience in Utilization Review or Home Health.

    • This is a fully remote contract position, but applicants must be located in New Mexico. Candidates must have access to the required equipment, including a laptop, keyboard, mouse, headset, and two monitors.

    Company Description

    Using the best business practices obtained from many years of experience in Business, Law, and Recruiting and Staffing, the Founders at CrossFire Group (“CrossFire”) started in downtown Royal Oak, MI more than a decade ago. With backgrounds in Information Technology (IT) and the Legal Industry, CrossFire began placing by IT and Legal Professionals in contract and direct-hire positions throughout the Midwest.

    Since our founding, CrossFire has grown into a full-service Human Capital Solutions Organization. We are proud of now providing full services beyond recruiting and staffing. Our portfolio of services includes HR supply chain management, human resources consulting, and many customized Human Resource related services.

    Company Description

    Using the best business practices obtained from many years of experience in Business, Law, and Recruiting and Staffing, the Founders at CrossFire Group (“CrossFire”) started in downtown Royal Oak, MI more than a decade ago. With backgrounds in Information Technology (IT) and the Legal Industry, CrossFire began placing by IT and Legal Professionals in contract and direct-hire positions throughout the Midwest. Since our founding, CrossFire has grown into a full-service Human Capital Solutions Organization. We are proud of now providing full services beyond recruiting and staffing. Our portfolio of services includes HR supply chain management, human resources consulting, and many customized Human Resource related services.

    Salary : $46

    If your compensation planning software is too rigid to deploy winning incentive strategies, it’s time to find an adaptable solution. Compensation Planning
    Enhance your organization's compensation strategy with salary data sets that HR and team managers can use to pay your staff right. Surveys & Data Sets

    What is the career path for a Care Review Clinician?

    Sign up to receive alerts about other jobs on the Care Review Clinician career path by checking the boxes next to the positions that interest you.
    Income Estimation: 
    $64,196 - $89,573
    Income Estimation: 
    $69,387 - $87,587
    Income Estimation: 
    $82,286 - $101,931
    Income Estimation: 
    $78,070 - $94,140
    Income Estimation: 
    $103,451 - $147,195
    Income Estimation: 
    $140,279 - $184,407
    Income Estimation: 
    $95,686 - $120,121
    Income Estimation: 
    $116,256 - $149,125
    Income Estimation: 
    $77,596 - $95,368
    Income Estimation: 
    $103,451 - $147,195
    Income Estimation: 
    $140,279 - $184,407
    Income Estimation: 
    $95,686 - $120,121
    Income Estimation: 
    $116,256 - $149,125
    Income Estimation: 
    $64,521 - $80,208
    Income Estimation: 
    $103,451 - $147,195
    Income Estimation: 
    $140,279 - $184,407
    Income Estimation: 
    $95,686 - $120,121
    Income Estimation: 
    $116,256 - $149,125
    Employees: Get a Salary Increase
    View Core, Job Family, and Industry Job Skills and Competency Data for more than 15,000 Job Titles Skills Library

    Job openings at Med National Staffing Inc.

    Accounts Payable
    Med National Staffing Inc.
    Hired Organization Address Long Beach, CA Temporary
    Accounts Payable Specialist – Hybrid (Long Beach, CA) Location: Hybrid –Long Beach, CA 90802 (In-office on Tuesdays and ...
    Laborer
    Med National Staffing Inc.
    Hired Organization Address Watertown, WI Full Time
    Job Summary Performs a variety of general manual labor tasks under direct supervision. Essential Duties and Responsibili...
    Registered Nurse Discharge Planning Specialist
    Med National Staffing Inc.
    Hired Organization Address Sacramento, CA Temporary
    Registered Nurse – Discharge Planning (Remote, CA) | $45.99/hr Job Overview: Molina Healthcare of CA is seeking two Regi...
    RN Fraud Waste & Abuse Investigator
    Med National Staffing Inc.
    Hired Organization Address San Diego, CA Temporary
    Location: Remote (Must Reside in Southern California & Hold CA RN License ) Schedule: Monday – Friday, 8:00 AM – 5:00 PM...
    View More Jobs at Med National Staffing Inc.

    Not the job you're looking for? Here are some other Care Review Clinician jobs in the Albuquerque, NM area that may be a better fit.

    Care Review Clinician I

    Careers Integrated Resources Inc, Albuquerque, NM

    Care Review Clinician, Inpatient Review (RN)

    Lensa, Rio Rancho, NM

    View More Jobs

    AI Assistant is available now!

    Feel free to start your new journey!