Care Review Clinician II

Integrated Resources, Inc

Troy, Michigan

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JOB DETAILS

JOB TYPE

Contractor

SKILLS

Behavioral Health, Certified Case Manager (CCM), Clinical Research, Communication Skills, Community Relations, Computer Skills, Computer Systems, Consulting, Cost Control, Cost Effectiveness Analysis, Data Entry, Discharge Plans, Federal Laws and Regulations, HIPAA (Health Insurance Portability and Accountability Act), Healthcare, Hospital, Information Technology & Information Systems, Long-Term Care, Medical Records, Mentoring, Microsoft Office, Microsoft Product Family, Multitasking, National Committee for Quality Assurance (NCQA), Nursing Management, Organizational Skills, Patient Care, Presentation/Verbal Skills, Problem Solving Skills, Project Planning, Quality Metrics, Registered Nurse (RN), Rehabilitation Nursing, Safety Compliance, Safety Standards, Safety/Work Safety, State Laws and Regulations, Time Management, Utilization Management, Writing Skills

LOCATION

Troy, Michigan

POSTED

Today

Care Review Clinician IIIntegrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing.Job DescriptionTitle: Care Review Clinician IILocation: Troy, MIDuration: 3+ Months (possible extension)Responsibilities:Shift: M-F 8:30 am to 5 pmWill be an inpatient UM, get cases from hospitals, review info about patient, enter info into computer system (interqual, or MCG) determine if it meets criteria, work with medical director for approval, and notify Hospital of approval.Follow members from admission process all the way through to discharge, find discharge plan and where patient is being discharged to.Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Healthcare 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 for members as part of the Utilization Management team.Identifies appropriate benefits, eligibility, and expected length of stay for members requesting treatments and/or procedures.Participates in interdepartmental integration and collaboration to enhance the continuity of care for members including Behavioural Health and Long Term Care.Maintains department productivity and quality measures.Attends regular staff meetings.Assists with mentoring of new team members.Completes assigned work plan objectives and projects on a timely basis.Maintains professional relationships with provider community and internal and external customers. Conducts self in a professional manner at all times.Maintains cooperative and effective workplace relationships and adheres to company Code of Conduct.Consults with and refers cases to medical directors regularly, as necessary.Complies with required workplace safety standards.Knowledge/Skills/Abilities:Demonstrated ability to communicate, problem solve, and work effectively with people.Excellent organizational skill with the ability to manage multiple priorities.Work independently and handle multiple projects simultaneously.Knowledge of applicable state, and federal regulations.In depth knowledge of Interqual and other references for length of stay and medical necessity determinations.Experience with NCQA.Ability to take initiative and see tasks to completion.Computer Literate (Microsoft Office Products).Excellent verbal and written communication skills.Ability to abide by policies.Ability to maintain attendance to support required quality and quantity of work.Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).Skilled at establishing and maintaining positive and effective work relationships with co-workers, clients, members, providers and customers.Required Education:Completion of an accredited Registered Nursing program. (A combination of experience and education will be considered in lieu of Registered Nursing degree).Required Experience:Minimum 2-4 years of clinical practice. Preferably hospital nursing, utilization management, and/or case management.Required Licensure/Certification:Active, unrestricted State Nursing (RN) license in good standing.

Care Review Clinician II

Integrated Resources, Inc

Troy, Michigan

About the Company

Integrated Resources, Inc

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