Clinical Review Nurse
4 weeks ago
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
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
- 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
- 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
If you are interested in this position, please apply OR submit your resume to:
Seniority level- Mid-Senior level
- Full-time
- Health Care Provider
- Staffing and Recruiting
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