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Clinical Reviewer
Carecentrix | |
United States | |
August 12, 2022 | |
Clinical Reviewer --Remote Job ID: 2022-13833 Type: Regular Full-Time # of Openings: 1 Category: Clinical / Utililization Management CareCentrix Overview Be part of something bigger-make an impact in a growing organization! CareCentrix is committed to making the home the center of patient care. Clinical Reviewers are responsible for the Utilization Management and review of clinical information for service requests received and to render a medical necessity approval or recommended denial to the Medical Director. As part of this process, you will evaluate information concerning patient care and match those needs with available care options, consistent with CareCentrix guidelines and specific plan payer criteria. Responsibilities In this Job, you will:
This is the job for you if:
Qualifications You should get in touch if: (experience & education) - You have an Associate's Degree or Diploma in Nursing/Practical Nursing (required) - You are a Registered Nurse/LPN/LVN with Licensure in the state(s) of practice (based on allowable state practice act) - You hold an active, current and unrestricted license (required). - You have a minimum of 1-2 years prior authorization experience for Medicare or Medicare Advantage Home Health required. - You have a minimum of 2 years in a clinical setting (required). - You have 1-2 years experience in Interqual (desired). - You hold strong knowledge of Medicare PDGM and 1-2 years process experience strongly desired. - You hold a broad knowledge of health care delivery/managed care regulations, contract terms/stipulations, prior utilization management/review experience, and governmental home health agency regulations preferred. - You possess proficient analytical, negotiation, communication, problem solving and decision making skills (required). What we offer: - Comprehensive Health, Dental, and Vision plans with HSA Employer Contributions and Dependent Care FSA Employer Match - Generous PTO, 401K Savings Plan, Paid Parental Leave, and Tuition Reimbursement - Access to earned income between paychecks and financial support via PayActiv - Complimentary on-demand fitness, mindfulness, and nutrition via Wellbeats - Great culture with a sense of community, with career growth and development opportunities . . What we offer:
CareCentrix maintains a drug-free workplace. We are an equal opportunity employer. Employment selection and related decisions are made without regard to age, race, color, national origin, religion, sex, disability, sexual orientation, gender identification, or being a qualified disabled veteran or qualified veteran of the Vietnam era or any other category protected by Federal or State law. Please see job description PI188697412 |