ColumbusRecruiter Since 2001
the smart solution for Columbus jobs

Care Review Clinician II

Location: Columbus
Posted on: January 14, 2021

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.

Keywords: , Columbus , Care Review Clinician II, Healthcare , Columbus, Ohio

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Healthcare Jobs


Registered Nurse - OR - 13 Week Contract
Description: Jackson is in need of highly-skilled Registered Nurses with experience caring for patients requiring surgical procedures for a 13 week contract assignment at a state-of-the-art area hospital. br You'll (more...)
Company: Jackson Nurse Professionals
Location: Mansfield
Posted on: 01/20/2021

State Tested Nursing Assistant
Description: State Tested Nurse br Aide STNA - Earn Bonuses, Rewards, and Hazard Pay br br Who We Are: br At connectRN, we believe that nurses and nursing professionals are the heart of healthcare. Using (more...)
Company: ConnectRN
Location: Fairfield
Posted on: 01/20/2021

Medical Support
Description: ABOUT Medical emergencies happen and we need people who can take charge when they do. Whether you're in a hospital or clinical setting, on a ship or submarine, or out in the field alongside fellow Sailors (more...)
Company: Navy
Location: Middletown
Posted on: 01/20/2021


Occupational Therapist - Nationwide Travel / Locum Tenen
Description: Of all the Healthcare Professional specialties we offer, Occupational Therapist are one of the specialties that have the most difference between staffing agencies in job / travel assignment locations (more...)
Company: HCEN Travel Solutions
Location: Middletown
Posted on: 01/20/2021

Endocrinology Physician
Description: Job Description RequirementsStart Date:1/30/2021Available Shifts:Call 1:3Job Type:Permanent Thriving, well-established practice located 30 minutes outside of Columbus, OH, is looking for a board-certified (more...)
Company: Merritt Hawkins
Location: Newark
Posted on: 01/20/2021

Cincinnati - Licensed Practical Nurse (LPN): $26-$28/hr - Earn Bonuses, Rewards, and Hazard Pay
Description: Licensed Practical Nurse LPN - Earn Bonuses, Rewards, and Hazard PayWho We Are: At connectRN, we believe that nurses and nursing professionals are the heart of healthcare. Using our mobile app, our (more...)
Company: ConnectRN
Location: Middletown
Posted on: 01/20/2021

Med Surg
Description: Health care professional needed for a Med Surg position in OH. Must have a minimum of 2 years experience as a Med Surg
Company: Titan Medical
Location: Mansfield
Posted on: 01/20/2021

Surgical Technologist CST/ST Travel
Description: Travel Surgical Technician Numerous Nationwide Travel Assignments / JobsGeneral Surgery / Cardiac / Ortho / Neuro / L D experience CST / STTired of completing an application just to get informationClick (more...)
Company: HealthCare Traveler (Allied Health)
Location: Middletown
Posted on: 01/20/2021

RN Stepdown
Description: RN Stepdown - Jan 5, 2021 - ul li Travel li Mansfield, OH 44903 li Posted 2 weeks ago li Degree Name: RN li Specialty: Stepdown li Shift:
Company: Alto Health Care Staffing
Location: Mansfield
Posted on: 01/20/2021

Travel Nurse RN - Dialysis - $1,224 per week
Description: MedPro Healthcare Staffing is seeking a travel nurse RN Dialysis for a travel nursing job in Mansfield, Ohio.Job Description Requirements ul li Specialty: Dialysis li Discipline: RN li Start (more...)
Company: NurseFly
Location: Mansfield
Posted on: 01/20/2021

Log In or Create An Account

Get the latest Ohio jobs by following @recnetOH on Twitter!

Columbus RSS job feeds