2 Jobs in Phoenix, AZ
Morgan Stephens is Hiring a Remote Care Review Clinician (Remote)
Location: Remote (USA)
Schedule: Monday - Friday, 8 AM to 5 PM CST
Experience Required: 3 years of hospital acute care/medical experience, UM experience
SummaryAs a Care Review Clinician, you will be an integral part of the Utilization Management team, focusing primarily on inpatient medical necessity/utilization review and various utilization management activities. Your role is crucial in ensuring that MCO (Managed Care Organization) members receive timely, appropriate, and cost-effective care while adhering to state and federal regulations and guidelines.
Essential Functions
- Conduct concurrent review and prior authorizations (as needed) according to MCO policy for MCO members as part of the Utilization Management team.
- Identify appropriate benefits, eligibility, and expected length of stay for members seeking treatments and procedures.
- Collaborate with other departments to enhance the continuity of care for MCO members, including Behavioral Health and Long-Term Care.
- Maintain department productivity and quality measures.
- Attend regular staff meetings.
- Assist in mentoring new team members.
- Complete assigned work plan objectives and projects in a timely manner.
- Foster professional relationships with the provider community and internal/external customers.
- Consult regularly with MCO medical directors and refer cases as necessary.
- Comply with required workplace safety standards.
- Strong communication skills, problem-solving abilities, and effective interpersonal interactions.
- Exceptional organizational skills, with the capacity to manage multiple priorities.
- Ability to work independently and handle multiple projects simultaneously.
- Knowledge of applicable state and federal regulations.
- Proficiency in Interqual and other references for length of stay and medical necessity determinations.
- Experience with NCQA.
- Initiative and commitment to task completion.
- Computer literacy, particularly with Microsoft Office products.
- Excellent verbal and written communication skills.
- Adherence to MCO's policies.
- Punctuality and attendance to support required work quality and quantity.
- Maintenance of confidentiality and compliance with the Health Insurance Portability and Accountability Act (HIPAA).
- Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers, and customers.
Required Experience: Minimum 2-4 years of clinical practice, preferably in hospital nursing, utilization management, and/or case management.
Duration: Temp-to-PermanentRequired Licensure/Certification: Active, unrestricted State Nursing (RN, LVN, LPN) license in good standing.
Job Summary
Full Time
$62k-87k (estimate)
05/12/2024
06/09/2024
morganstephens.com
TALLAHASSEE, FL
<25
2014
JOSEPH TOLLAND
<$5M
Related Companies
The job skills required for Care Review Clinician (Remote) include Managed Care, Utilization Management, Prior Authorization, Acute Care, Confidentiality, Microsoft Office, etc. Having related job skills and expertise will give you an advantage when applying to be a Care Review Clinician (Remote). That makes you unique and can impact how much salary you can get paid. Below are job openings related to skills required by Care Review Clinician (Remote). Select any job title you are interested in and start to search job requirements.
The following is the career advancement route for Care Review Clinician (Remote) positions, which can be used as a reference in future career path planning. As a Care Review Clinician (Remote), it can be promoted into senior positions as an Utilization Review Manager - Home Care that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Care Review Clinician (Remote). You can explore the career advancement for a Care Review Clinician (Remote) below and select your interested title to get hiring information.
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