Clinical Review Nurse

2 days ago

Melbourne, Victoria, Australia A-Line Staffing Solutions Full time
Overview

A-Line Staffing Solutions is hiring a remote clinical review RN with a large managed care organization working on the west coast (CA, OR, or WA).

Job Title: Utilization Review RN

Pay: $40 per hour

Job Type: Full-time

Shift Options
  • Training going from 6AM-3PM PST Mon-Fri (2 weeks, NO TIME OFF)
  • 10-7 PST Tuesday-Saturday
  • 10-7 PST Sunday-Thursday
  • 8-5 PST Monday-Friday
Utilization Review Case Manager RN Overview

Performs concurrent reviews, including determining member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies and guidelines. Assists evaluating inpatient services to validate the necessity and setting of care being delivered to the member. Specific to the denial letters.

  • Perform concurrent clinical reviews for healthcare plans
  • Evaluate patient records and ensure compliance with treatment protocols
  • Collaborate with healthcare providers to validate appropriateness of care
  • Document findings and communicate recommendations to team
  • Conduct reviews according to schedule and company standards
Utilization Review Case Manager RN Qualifications
  • RN with current licensure in State of residence (CA, WA, or OR)
  • 3+ years of clinical experience required
  • 2+ years' experience working with utilization review or prior authorization documentation
  • Bachelors of Nursing (BSN) preferred
  • Minimum of Associates or Diploma nursing degree required
Utilization Review Case Manager RN Benefits
  • Benefits are available to full-time employees after 90 days of employment and include health, optical, dental, life, and short-term disability insurance
  • A 401(k) with a company match is available for full-time employees with 1 year of service on our eligibility dates
How To Apply

If you are interested in this position, please apply OR submit your resume to:

Seniority level
  • Mid-Senior level
Employment type
  • Full-time
Job function
  • Health Care Provider
Industries
  • Staffing and Recruiting

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