What are the responsibilities and job description for the Clinical Reviewer position at Integrated Resources, Inc ( IRI )?
Job Title: Care Review Clinician II
Location: 100% Remote (Must work PST hours)
Duration: 6 Months (Potential for Extension)
Work Schedule:
- Fully remote – Must adhere to PST time zone
- Typical hours: 8 AM – 5 PM PST, Monday-Friday or 8:30 AM – 5:00 PM PST Tuesday-Saturday would be preferable
Job Description:
- This position is fully remote; however, client prefers someone who lives in the West Coast.
- Must be Licensed in the state of Washington as Social Worker, Mental Health Counselor, Marriage Family Therapist, or Psychiatric Nurse.
- Must have Utilization Management Experience, Behavioral Health Background.
Day-to-day job duties: Medical Necessity reviews for behavioral health levels of care.
Summary:
- Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Client’s 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.
Required Qualification:
- Required Experience: Minimum 2-4 years of clinical practice. Preferably utilization management.
- Required Licensure/Certification: Active, unrestricted Washington state license as Social Worker, Mental Health Counselor, Marriage Family Therapist, or Psychiatric Nurse in good standing.