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Clinical Care Evaluator

2 months ago

California, United States Workpath Partners Full time
Position Overview:
We are seeking a Clinical Care Evaluator to become a vital part of our expanding team at Workpath Partners. This role offers a competitive hourly compensation of $45.22.

Key Responsibilities:
  • Collaborates with the Utilization Management team, focusing on inpatient medical necessity assessments and various utilization management tasks to ensure Healthcare members receive appropriate care at the right time and place.
  • Conducts daily evaluations of members needing hospitalization or procedures, providing necessary prior authorizations and concurrent reviews.
  • Reviews services for members to guarantee optimal outcomes, cost efficiency, and adherence to all relevant state and federal regulations.

Essential Duties:
  • Executes concurrent reviews and prior authorizations in accordance with policy for members as part of the Utilization Management team.
  • Determines suitable benefits, eligibility, and anticipated length of stay for members seeking treatments or procedures.
  • Engages in interdepartmental collaboration to improve continuity of care for members, including Behavioral Health and Long Term Care.
  • Upholds departmental productivity and quality standards.
  • Participates in regular team meetings.
  • Aids in mentoring new team members.
  • Completes assigned objectives and projects within designated timelines.
  • Fosters professional relationships with the provider community and both internal and external stakeholders.
  • Maintains a professional demeanor at all times.
  • Cultivates cooperative and effective workplace relationships while adhering to the company’s Code of Conduct.
  • Regularly consults with and refers cases to medical directors as necessary.
  • Adheres to required workplace safety protocols.

Job Type:
Full-time
Compensation:
$45.22 per hour

Schedule:
  • 8-hour shifts
  • Day shifts
  • Monday to Friday

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

Licensure/Certification:
  • California RN License (Required)

Work Location:
Remote