Details of Job
Type of work
Initial Clinical Reviewer
Complete Job Description
RN functions in the clinical review capacity of all cases, which do not pass the authorization process on the first call while promoting the support team approach and call center staff. Early clinical reviewers supported Clinical Review staff (MDs) in the process of determining use management.
- Hours of operation are: Monday - Friday, 9:00 am 5:30 pm CST.
- This remote, operates from home
- Review the charts and analyze clinical records to approve services that meet the clinical evaluation process.
- Perform ongoing activities that monitor the quality of care levels in the network of participating providers and other clinic staff.
- He conducts regular audits, as provided, to ensure that guidelines are applied effectively.
- In provinces where required, it refers to all cases where consent may not be granted to the Clinical Reviewer. In countries where it is permissible, it will make the refusal decisions as certain authoritative conditions.
- Consult with medical staff to obtain the relevant clinical history / information; inform approval and rejection, providing clinical reasons.
- Provides comprehensive customer service with professional / accurate communication while maintaining the required timelines for the health plan.
- Documents all communications with medical office staff and / or medical provider.
- Develop and maintain usage management policies in accordance with policies and procedures.
- Participates in ongoing training programs to ensure quality performance in accordance with applicable standards and regulations.
Other Job Requirements
Responsibilities
- Bachelor's degrees with Interventional Pain Management experience or related field.
- One year of managed care or UM with 5+ years of preferred clinical experience.
You must have a current license as RN.
An RN license is required and a specific State license may be required depending on the contract / business agreement.
A license is required for this position, especially a current license that meets the requirements of the State, Commonwealth or customer.
Strong social and interpersonal skills.
Basic computer skills; must be able to speak and type at the same time.
Job Job Details
Title
First Clinic Reviewer - RN, Incoming Pain Management
Distance
24
Work experience
Clinic
Education
Partners: Nursing (Required), degree
Licenses and Certificates - Required
ASRT - American Society of Technologists Certification OT - Occupational Therapist, State Licensure - Care Mgmt, PT - Physical Therapist, State Licensure - Care Mgmt, RN - Registered Nurse, State and / or Compact State Licensure - Care Mgmt , ST - Speech Specialist, Government License - Care Mgmt
Licenses and Certificates - Preferences
Magellan Health Services prides itself on being an equal opportunity employer with a non-smoking workplace. EOE / M / F / Vet / Disabled. All employees must understand, comply with and validate safety and security obligations that are different from their positions.
Magellan Health
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