What are the responsibilities and job description for the RN Clinical Review Nurse position at Mitchell Martin?
One of our Clients, is looking for an RN Clinical Review Nurse
Position Type : Contract
Location : New York
Schedule : Mon-Fri 8 : 30 am-5 : 30 pm (1 hour lunch)
JOB RESPONSIBILITIES :
Processes requests for authorization from in-network providers and communicates in a timely manner when the decision has been made by the Interdisciplinary Team (IDT).
Collects, reviews, and evaluates information necessary to reach prospective, concurrent and retrospective decisions using objective evidence-based clinical criteria.
Suggests alternate care plans, makes recommendations and coordinates with the Provider / IDT for appropriate utilization of services.
Documents case reviews, associated communications, and outcomes in the electronic case file.
Presents cases to the site Physician and / or Medical Director for review and determination.
Works closely with the Physician and / or Medical Director to ensure that medical review of specific cases occurs timely and meets standards for decision turnaround times.
Participates in periodic inter-rater reliability testing on medical necessity criteria application.
Recognizes and refers potential quality of care concerns to Quality Management
QUALIFICATIONS : Education :
Required Experience :
Minimum of three to five (3 - 5 ) years' experience in a hospital or home care clinical setting.
Knowledgeable about Medicare and Medicaid guidelines.
Case Management and discharge planning experience is beneficial.
Two to three (2 - 3) years of Utilization Review experience at a Managed Care Organization is preferred
Please email : alexc@hcmmi.com Learn More
