Clinical Review Nurse

Job Position: Clinical Review NurseLocation: Chicago, IL (Remote)Pay Rate: $42.00-$44.00/hour, based on experienceShift: 8:30-5 CST; Tues- Sat Position Purpose: Analyzes all prior authorization requests to determine medical necessity of service and appropriate level of care in accordance with national standards, contractual requirements, and a member's benefit coverage.Job Responsibilities:● Provides recommendations to the appropriate medical team to promote quality and cost effectiveness of medical care. ● Performs medical necessity and clinical reviews of authorization requests to determine medical appropriateness of care in accordance with regulatory guidelines and criteria ● Works with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care ● Coordinates as appropriate with healthcare providers and interdepartmental teams, to assess medical necessity of care of member ● Escalates prior authorization requests to Medical Directors as appropriate to determine appropriateness of care ● Assists with service authorization requests for a member’s transfer or discharge plans to ensure a timely discharge between levels of care and facilitiesRequired Education and Experience● Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing required. ● 2 years of Clinical knowledge and ability to analyze authorization requests and determine medical necessity of service required. ● Knowledge of Medicare and Medicaid regulations preferred. ● Knowledge of utilization management processes preferred. ● Knowledge of healthcare and managed care preferred. ● Prior experience working in a remote role is preferred. INDHPAltaStaff is an Equal Employment Opportunity Employer. We provide equal employment opportunities to all qualified applicants for employment without regard to age, race, color, creed, religion, sex, marital status, national origin, ancestry, citizenship, disability, veteran status, sexual orientation, or any other protected status, in accordance with applicable federal, state, and local laws.

Salary : $42 - $44