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
Max pay is $37.25/hour.
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.
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.
Must have a valid OH RN license
Utilization Management/Review experience in either a hospital or
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