Care review Clinician | Utilization review nurse

Careers Integrated Resources IncLong Beach, CA, US

20 days ago

Job type

Full-time

Job description

Job Title : Care review Clinician | Utilization review nurse

Location : 100% Remote in CA

Duration : 06 months+ contract (Possibility of extension)

Shift timings : Standard hours - 8 : 00 AM to 5 : 00 PM (Mon-Fri)

Pay Rate - $47.14 / hr on W2

Job Summary :

Processing pediatric inpatient authorizations, Pediatrics, CCS and UM
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.

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Utilization Review Nurse • Long Beach, CA, US

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