Care Review Clinician

AltaStaff is a staffing agency currently looking for a Care Review Clinician I to work with our Managed Care Client!

Pay Rate: $35 - 42 hourly

Schedule: M-F, 8am-5pm

***This is a fully remote role but candidates must be RN or LPN/LVN licensed in Texas***

Position Purpose: Care Review Clinician works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review aimed at providing members with the right care.

• Completes/reviews Inpatient Authorizations, reviewing faxes that can be 50-100 pages long

• Will be expected to manage 25-30 cases successfully daily.

• Should be able to quickly and accurately determine whether the criteria meet medical necessity.

• Provides daily review and evaluation of members that require hospitalization and/or procedures providing prior authorizations and/or concurrent review.

• Assesses services for Molina Members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and

• guidelines.

• Provides concurrent review and prior authorizations (as needed) according to Molina policy for Molina members as part of the Utilization Management team.

• Additional duties assigned

Education/Experience: 

• RN or LPN/LVN license in Texas required

• Must have 2+ years clinical practice experience (hospital, case management, utilization management)

• Must have at least 1 year Utilization Management experience in a HP setting; MCG experience preferred

• Must have experience in prior authorizations and/or behavioral health outpatient services

• Must have the ability to complete 15-20 authorization in a day

• Previous experience working using QNXT/UMK2/PEGA preferred

If you've applied and would like to view your application status, please visit: https://altastaff.zenople.com/login/ALTA

AltaStaff 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.

INDLP

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