Overview:
We are seeking a dedicated Clinician to join our team.

All UM standard/ expedited Inpatient, Outpatient and Custodial Care clinical reviews for MLTC members.

Day to Day Responsibilities:

All UM standard Inpatient, Outpatient and Custodial Care processes and workflows for any requests, verbal notifications for denials/partial denials to both member and provider, participation in IDTs, personal queue management and clinical reviews. Summary:

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 members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines..

Job Type: Full-time

Pay: $40.95 - $40.96 per hour

Schedule:

• 8 hour shift
• Monday to Friday

Experience:

• Utilization Management: 2 years (Required)
• Medicaid: 2 years (Preferred)
• MLTC: 2 years (Required)
• MCG: 2 years (Preferred)

License/Certification:

• New York RN License (Required)
• New York LPN License (Preferred)

Location:

• New York State (Required)

Work Location: Remote