Care Review Clinician II

Location: Columbus
Posted on: October 29, 2024

Job Description:

Industry leading managed care organization is seeking a Care Review Clinician II to work in Columbus, OH.

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

Max pay is $37.25/hour.

SUMMARY:

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

Identifies appropriate benefits, eligibility, and expected length of stay for members requesting treatments and/or procedures.

Requirements:

Must have a valid OH RN license

Utilization Management/Review experience in either a hospital or insurance org

Interqual (preferred) or Milliman experience

A minimum of 5 years total experience, including some clinical

Must understand patient/hospital standards

Attention to detail

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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