Clinical Review Nurse - Temporary
FlexStaff is seeking a Temporary Clinical Review Nurse for our client, a non-profit healthcare organization providing home and community-based healthcare and services for the elderly.
Location: Uniondale
Setting: Hybrid (In office/remote work)
Pay Rate: $64/hr
Schedule: Monday - Friday 8:30 am-5:30 pm (1 hour lunch)
Contract Length: Undetermined, potential for Direct Hire
Under the direction of the Senior Director of Clinical Review, the Clinical Review Nurse 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 criteria. The Senior Director of Clinical Review will monitor the Clinical Review Nurse's activities and outcomes, ensuring compliance with established regulatory and contractual requirements.
RESPONSIBILITIES:
- Processes requests for authorization from in-network providers and communicates in a timely manner when the decision has been made by the Interdisciplinary Team (IDT).
- Collects, reviews, and evaluates information necessary to reach prospective, concurrent and retrospective decisions using objective evidence-based clinical criteria.
- Suggests alternate care plans, makes recommendations and coordinates with the Provider/IDT for appropriate utilization of services.
- Documents case reviews, associated communications, and outcomes 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 timely and meets standards for decision turnaround times.
- Participates in periodic inter-rater reliability testing on medical necessity criteria application.
- Recognizes and refers potential quality of care concerns to Quality 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 Medicaid 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 Microsoft Office and Microsoft Excel 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 projects and be flexible.
- Able to travel to any of the various locations, as needed. Additional Salary Detail
The salary range and/or hourly rate listed is a good faith determination of potential base 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 future. When determining a team member's base salary and/or rate, several factors may be considered as applicable (e.g., location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget and internal equity).
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