What are the responsibilities and job description for the Clinical Services Review Nurse position at MotivHealth?
Overview: The Clinical Services Review Nurse position works directly with MotivHealth’s Medical Director to perform Utilization Management (UM) and Case Management (CM) functions.
Responsibilities and Duties
- Performs clinical intake and reviews cases according to policies and procedures of MotivHealth
- Collects and enters confidential information ensuring the highest level of confidentiality in all areas
- Reviews clinical information against MotivHealth criteria and follows appropriate workflow
- Maintains written documentation according to MotivHealth’s documentation policy
- Provides quality customer service through interaction with members, providers, administrative staff, and others.
- Business focus demonstrates an understanding of the company’s vision, mission, and strategy
- Creates, encourages, and supports an environment that fosters teamwork, respect, diversity, and cooperation with others
- Adheres to all HIPAA, state and federal regulations pertaining to the clinical programs
- Collaborates with Human Resources to ensure adherence to company policies
- Performs other related duties and projects as assigned
Qualifications
- Graduate of an accredited school of nursing
- Current active unrestricted RN license in a state or territory of the U.S.
- Five years of prior experience in direct clinical care or managed care setting required
- Excellent interpersonal, written and presentation skills, including the ability to handle interactions with facility personnel, providers, members, and various internal departments in a professional manner
- Ability to work in a fast-paced, evolving environment, on-call after hours work may be required
- Ability to utilize critical thinking skills
- Strong interpersonal and communication skills
- Highly motivated, self-starter who works independently using all available resources, policies, and procedures to work effectively and meet required timelines
- Minimum of 2 years of health care or health plan experience
- Knowledge of Microsoft Office and programs including Outlook, PowerPoint, Excel, and Word
- Easily able to adapt to change in a fast-growing company
Salary : $27 - $38
