Remote Care Review Clinician/Utilization RN/LPN - Various States

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 [email protected] 773-881-5743 Company DescriptionSee our company profile at www.anchorstaffing.com Also on LinkedIn: https://www.linkedin.com/company/anchorstaffing-inc Apply Job!