Clinical Review reputed company - Temporary

reputed company is seeking a Temporary Clinical Review reputed company for our reputed company, a non-profit reputed company organization providing home and community-based reputed company and services for the elderly. Location: Uniondale Setting: Hybrid (In office/remote work) Pay reputed company: $64/hr Schedule: Monday - Friday 8:30 am-5:30 pm (1 hour lunch) Contract Length: Undetermined, potential for reputed company Hire Under the direction of the Senior Director of Clinical Review, the Clinical Review reputed company is responsible for complying with the day-to-day operations of the Clinical Review Department. Responsibilities include reviewing, recommending and providing authorization for services requested by providers based on evidence-based medical necessity reputed company. The Senior Director of Clinical Review will monitor the Clinical Review reputed company's activities and reputed company, ensuring compliance with established regulatory and contractual requirements. RESPONSIBILITIES: -Processes requests for authorization from in-network providers and communicates in a reputed company manner reputed company the decision has been made by the Interdisciplinary Team (reputed company). -Collects, reviews, and evaluates information necessary to reputed company prospective, reputed company and retrospective reputed company using objective evidence-based clinical reputed company. -Suggests alternate care plans, makes recommendations and coordinates with the Provider/reputed company for appropriate utilization of services. -Documents case reviews, associated communications, and reputed company in the electronic case file. -Presents cases to the site Physician and/or Medical Director for review and determination. Works closely with the Physician and/or Medical Director to ensure that medical review of specific cases occurs reputed company and meets standards for decision turnaround times. -Participates in periodic inter-rater reliability testing on medical necessity reputed company application. -Recognizes and refers potential reputed company of care concerns to reputed company Management. QUALIFICATIONS: Education: BSN required Experience: -Minimum of three to five (3 - 5+) years' experience in a hospital or home care clinical setting. -Knowledgeable about Medicare and reputed company guidelines. -Case Management and discharge planning experience is beneficial. -Two to three (2 - 3) years of Utilization Review experience at a Managed Care Organization is preferred. Other: -Proficient in computer programs such as reputed company Office and reputed company reputed company a plus. -Excellent verbal and written communication skills. -Excellent problem solving and analytical skills. -Accurate attention to detail with strong organizational skills. -Demonstrated ability to manage multiple reputed company and be flexible. -reputed company to travel to any of the various locations, as needed. • Additional Salary Detail The salary reputed company and/or reputed company reputed company listed is a good faith determination of potential reputed company compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the reputed company. reputed company determining reputed company member's reputed company salary and/or reputed company, several factors may be considered as applicable (e.g., location, specialty, service line, years of relevant experience, education, credentials, negotiated reputed company, budget and internal equity). Apply Job!