Care Review Clinician II - NO LPN

Location: Troy
Posted on: October 29, 2024

Job Description:

Prominent managed care organization is seeking a Care Review Clinician II to work in Troy, MI.

This is a three (3) to six (06) month contract position with the possibility of extension/temp to hire.

Max pay is $40.00/hour.

Summary:

This position is responsible for provider appeals, utilization reviews and assisting with denial letters.

Essential Functions:

Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing 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.

Requirements:

Must be an RN (or NP/PA)

Utilization background in either Managed Care of Provider environment (at least two years)

Experience with appeals highly preferred

Interqual experience a necessity

Other basic computer skills necessary: Microsoft Office, Data Entry, etc.

Needs to be a team player and good communicator

We are an equal employment opportunity employer and will consider all qualified candidates without regard to disability or protected veteran status.

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