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Job Title: Care Review Clinician ILocation: Remote (Must be local to NV)Duration: 3 MonthsJob Description: Position is remote, but candidates must be local to Nevada, - that is what clientprefers in the event we have an opportunity to consider for FT should an opening become availablebull; Schedule will be 8am - 5pm PST, 1 hour lunch break. Prefer Saturday worker with day off during the week. We have another nurse that works Saturday/off Thursday. Wednesdays would be the preferred day off, but possibly Mondaybull; a strong candidate will have some UM experience. Prefer UM experience; MCG criteria knowledge a plus Must Have Skills: Someone who is teachable with good work ethic. Quick learner and excellent attendanceJob Summary:* Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service. UM is rarely ever member-facing, will probably not work BHEquipment: Laptop, docking station, dual monitors, mouse, keyboard, and headset are needed. Management requires supplier issued equipment only, candidates are not permitted to use personal (link removed)ndidates must have a NV State RN license to be considered.Must Have Skills: Someone who is teachable with good work ethic.Job Description:Job Summary:* Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.KNOWLEDGE/SKILLS/ABILITIES: Assesses inpatient services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelinesbull; Analyzes clinical service requests from members or providers against evidence based clinical guidelinesbull; Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or proceduresbull; Conducts inpatient reviews to determine financial responsibility for * and its members. May also perform prior authorization reviews and/or related duties as neededbull; Processes requests within required timelinesbull; Refers appropriate cases to Medical Directors and presents them in a consistent and efficient mannerbull; Requests additional information from members or providers in consistent and efficient mannerbull; Makes appropriate referrals to other clinical programsbull; Collaborates with multidisciplinary teams to promote Client Care Modelbull; Adheres to UM policies and proceduresbull; Occasional travel to other Client offices or hospitals as requested, may be required. This can vary based on the individual State Plan.JOB QUALIFICATIONSRequired Education:Graduate from an Accredited School of Nursing.Required Experience:3+ years hospital acute care/medical experience.Required License, Certification, Association:Active, unrestricted State Registered Nursing (RN) license in good standing in the state of Nevada.Summary:Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing * members with the right care at the right place at the right time. Provides daily review and evaluation of members that require hospitalization and/or procedures providing prior authorizations and/or concurrent review. Assesses services for Client Members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.Essential Functions:Provides concurrent review and prior authorizations (as needed) according to Client policy for Client members as part of the Utilization Management team. Identifies appropriate benefits, eligibility, and expected length of stay for members requesting treatments and/or procedures. Participates in interdepartmental integration and collaboration to enhance the continuity of care for Client members including Behavioral Health and Long Term Care. Maintains department productivity and quality measures. Attends regular staff meetings. Assists with mentoring of new team members. Completes assigned work plan objectives and projects on a timely basis. Maintains professional relationships with provider community and internal and external customers. Conducts self in a professional manner at all times. Maintains cooperative and effective workplace relationships and adheres to company Code of Conduct. Consults with and refers cases to Client medical directors regularly, as necessary. Complies with required workplace safety standards.Knowledge/Skills/Abilities:Demonstrated ability to communicate, problem solve, and work effectively with people. Excellent organizational skill with the ability to manage multiple priorities. Work independently and handle multiple projects simultaneously. Knowledge of applicable state, and federal regulations. In depth knowledge of Interqual and other references for length of stay and medical necessity determinations. Experience with NCQA. Ability to take initiative and see tasks to completion. Computer Literate (Microsoft Office Products Excellent verbal and written communication skills. Ability to abide by Clients policies. Ability to maintain attendance to support required quality and quantity of work. Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA Skilled at establishing and maintaining positive and effective work relationships with coworkers, clients, members, providers and customers.Required Education:Completion of an accredited Registered Nursing program. (a combination of experience and education will be considered in lieu of Registered Nursing degreeRequired Experience:Minimum 0-2 years of clinical practice. Preferably hospital nursing, utilization management, and/or case management.Required Licensure/Certification:Active, unrestricted State Nursing (RN, LVN, LPN) license in good standing.