Clinical Care Specialist
4 weeks ago
Job Title: Clinical Care Specialist
Job Summary:
Motion Recruitment Partners LLC is seeking a skilled Clinical Care Specialist to join their team. As a Clinical Care Specialist, you will be responsible for reviewing and evaluating cases for medical necessity, collaborating with internal and external staff, and providing notifications to members and providers.
Responsibilities:
- Review and evaluate cases for medical necessity against medical policy, benefits, and/or care guidelines and regulations.
- Complete work in accordance with timeliness, production, clinical quality/accuracy, and compliance standards.
- Provide notifications to member and/or provider, according to regulatory requirements.
- Assess appropriateness for secondary case review by the Medical Director (MD) for denials and coordinate as needed.
- May coordinate peer-to-peer review upon provider request when members' health conditions do not meet guidelines.
Requirements:
- RN with 3 years of clinical experience or LPN with 5 years of clinical experience.
- Must have and maintain a valid and applicable clinical license (NC or compact multi-state licensure) to perform described job duties.
- Need to have prior authorization experience.
- Experience with Medicare, Case Utilization, and Care Radius is a plus.
Benefits:
- Medical Insurance - Four medical plans to choose from for you and your family.
- Dental & Orthodontia Benefits.
- Vision Benefits.
- Health Savings Account (HSA).
- Health and Dependent Care Flexible Spending Accounts.
- Voluntary Life Insurance, Long-Term & Short-Term Disability Insurance.
- Hospital Indemnity Insurance.
- 401(k) including match with pre and post-tax options.
- Paid Sick Time Leave.
- Legal and Identity Protection Plans.
- Pre-tax Commuter Benefit.
- 529 College Saver Plan.
About Us:
Motion Recruitment Partners LLC is an Equal Opportunity Employer, including Veterans/Disability/Women. All applicants must be currently authorized to work on a full-time basis in the country for which they are applying, and no sponsorship is currently available.
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