Care Review Clinician

2 weeks ago


California, United States Workpath Partners Full time
We are looking for a *Care Review Clinician *to join our growing team. You will be offered a competitive hourly rate of $45.22*/ hour. *

*Responsibilities of the Care Review Clinician:*
* Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Healthcare 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.

Essential Functions:
* Provides concurrent review and prior authorizations (as needed) according to policy for members as part of the Utilization Management team.
* Identifies appropriate benefits, eligibility, and expected length of stay for members requesting treatments and/or procedures.
* Participates in interdepartmental integration and collaboration to enhance the continuity of care for members including Behavioral Health and Long Term Care.
* Maintains department productivity and quality measures.
* Attends regular staff meetings.
* Assists with mentoring of new team members.
* Completes assigned work plan objectives and projects on a timely basis.
* Maintains professional relationships with provider community and internal and external customers.
* Conducts self in a professional manner at all times.
* Maintains cooperative and effective workplace relationships and adheres to company Code of Conduct.
* Consults with and refers cases to medical directors regularly, as necessary.
* Complies with required workplace safety standards.

Job Type: Full-time

Pay: $45.22 per hour

Schedule:
* 8 hour shift
* Day shift
* Monday to Friday

Experience:
* Managed care: 2 years (Required)
* Case Management: 2 years (Preferred)
* Utilization Management: 2 years (Required)
* MCG: 2 years (Preferred)
* Pediatrics: 2 years (Preferred)

License/Certification:
* California RN License (Required)

Location:
* California (Required)

Work Location: Remote

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