• Snapboard
  • Activity
  • Reports
  • Campaign
Welcome ,

Chat with the recruiter

...Minimize

Hey I'm Online! Leave me a message.
Let me know if you have any questions.

Care Review Clinician (RN/LPN/LVN) - Remote/Washington - 6 Months+

In California / United States

Save this job

Care Review Clinician (RN/LPN/LVN) - Remote/Washington - 6 Months+   

Click on the below icons to share this job to Linkedin, Twitter!

JOB TITLE:

Care Review Clinician (RN/LPN/LVN) - Remote/Washington - 6 Months+

JOB TYPE:

JOB SKILLS:

JOB LOCATION:

Long Beach California / United States

JOB DESCRIPTION:

Care Review Clinician

Location: Remote with Washington State License

Duration: 6 months (extendable)

Job Overview:

  • Must have a Washington state license (RN, LVN or LPN)
  • Utilization Management experience
  • Schedule: M-F, 8a-5p (with some flexibility on start/end times)
  • Required Licensure:

  • RN or LVN or LPN license in WA
  • Required Experience:

  • Minimum 1-3 years of hospital or medical clinic experience.

  • Required Licensure/Certification:

  • Active, unrestricted Washington State Registered Nursing (RN), Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) license in good standing OR a clinical license in good standing.
  • Must be able to travel within applicable state or locality with reliable transportation as required for internal meetings.
  • Preferred Experience:

    Minimum 3-5 years clinical practice with managed care, hospital nursing or utilization management experience.

    Preferred License:

    Utilization Management Certification (CPHM).


    Summary:

    Work with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

    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 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 the client Care Model

    Adheres to UM policies and procedures.

    Occasional travel to other client offices or hospitals as requested, may be required. This can vary based on the individual State Plan.

    Position Details

    POSTED:

    Aug 09, 2021

    EMPLOYMENT:

    INDUSTRY:

    SNAPRECRUIT ID:

    S16174662087094065

    LOCATION:

    California / United States

    CITY:

    Long Beach

    Job Origin:

    CEIPAL_ORGANIC_FEED

    A job sourcing event
    In Dallas Fort Worth
    Aug 19, 2017 9am-6pm
    All job seekers welcome!

    Care Review Clinician (RN/LPN/LVN) - Remote/Washington - 6 Months+    Apply

    Click on the below icons to share this job to Linkedin, Twitter!

    Care Review Clinician

    Location: Remote with Washington State License

    Duration: 6 months (extendable)

    Job Overview:

  • Must have a Washington state license (RN, LVN or LPN)
  • Utilization Management experience
  • Schedule: M-F, 8a-5p (with some flexibility on start/end times)
  • Required Licensure:

  • RN or LVN or LPN license in WA
  • Required Experience:

  • Minimum 1-3 years of hospital or medical clinic experience.

  • Required Licensure/Certification:

  • Active, unrestricted Washington State Registered Nursing (RN), Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) license in good standing OR a clinical license in good standing.
  • Must be able to travel within applicable state or locality with reliable transportation as required for internal meetings.
  • Preferred Experience:

    Minimum 3-5 years clinical practice with managed care, hospital nursing or utilization management experience.

    Preferred License:

    Utilization Management Certification (CPHM).


    Summary:

    Work with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

    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 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 the client Care Model

    Adheres to UM policies and procedures.

    Occasional travel to other client offices or hospitals as requested, may be required. This can vary based on the individual State Plan.


    Please wait..!!