Job Description
Remote Review Clinician: Payrate: $38.00 - $42.00
Seeking 2 RN/LPN from one of the following geographical locations: AZ, FL, GA, ID, IA, KY, MI, NE, NM, NY (outside greater-NYC), OH, TX, UT, WA (outside greater-Seattle), WI.
***COMPACT LICENSE IS PREFERRED****
Must have at least 1 year UM experience in a HP setting LPN or RN and the ability to work remote in a high pace/high demand environment.
Must work either EST or CST hours PLEASE REVIEW THE SCHEDULE OPTIONS BELOW
We need 2 Clinicians, 1 for Prior Authorizations and 1 for Inpatient
KNOWLEDGE/SKILLS/ABILITIES
• Assesses services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.
• Analyzes clinical service requests from members or providers against evidence based clinical guidelines. • Identifies appropriate benefits and eligibility for requested treatments and/or procedures.
• Conducts prior authorization reviews to determine financial responsibility for our MCO client and its members.
• Processes requests within required timelines. • Refers appropriate prior authorization requests to Medical Directors.
• Requests additional information from members or providers in consistent and efficient manner.
• Makes appropriate referrals to other clinical programs. • Collaborates with multidisciplinary teams to promote Care Model
• Adheres to UM policies and procedures.
The ability to complete 15-20 authorization in a day
Previous experience working for using QNXT/UMK2 preferred MCG Experience preferred.
Review Prior auth/Inpatient/Skilled Nursing requests for medical necessity using State/Policy or MCG criteria
Hours per Week: 40 hours with Weekend Rotation
Schedule Options:
CRC A - Tuesday (9 am – 6:30 pm) through Saturday (10 am – 2 pm)
CRC B – Sunday (10 am – 2 pm) Monday – Thursday (9 am – 6:30 pm)
CRC C Rotates each week: Monday, Tuesday, Thursday and Friday (8:30 am – 5pm) Off Sundays and Wednesdays Sunday (10 am – 6:30 pm) Monday (8:30 am – 5 pm) Wednesday through Friday (8:30 am – 5 pm) Off Tuesdays and Saturdays
For immediate consideration:
Kimberly Cameron, PHR
kcameron@anchorstaffing.com
773-881-5743
Company Description See our company profile at
Also on LinkedIn: -inc
See our company profile at on LinkedIn:
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