What are the responsibilities and job description for the Care review clinician position at MedNational Staffing?
All UM standard / expedited Inpatient, Outpatient and Custodial Care clinical reviews for MLTC members.
Must Have Skills :
Must have experience in UM, experience with Turnaround Timeframes, good with computer systems and be able to learn a new system, have done clinical reviews and processed denials and partial denial determinations, know MCG and can use it, case presentation for medical reviews, know Medicaid / Medicare guidelines.
Bi-lingual Spanish, Bengali or Mandarin. - PREFERRED
All UM standard Inpatient, Outpatient and Custodial Care processes and workflows for any requests, verbal notifications for denials / partial denials to both member and provider, participation in IDTs, personal queue management and clinical reviews.
Required Years of Experience :
At least 1-2 years' experience in UM.
Required Licensure / Education : Licensure required is a NY State License Practical Nurse or Registered Nurse -LPN NY & NY RN
Job Types : Full-time, Contract
Last updated : 2024-07-08