Remote Clinician I - Care Review
Get It - Healthcare
Date: 4 weeks ago
City: Long Beach, CA
Contract type: Full time
Remote
Job Overview
We invite dedicated and compassionate professionals to consider the position of Care Review Clinician I, working remotely within our esteemed healthcare services team. This pivotal role emphasizes collaboration with patients, healthcare providers, and a multidisciplinary team to assess, plan, and coordinate comprehensive care for individuals with intricate healthcare requirements. Your primary mission will be to guarantee that each patient receives optimal care in a timely manner and within the most suitable environment, all while ensuring adherence to cost-effectiveness and compliance with state and federal regulations.
Key Responsibilities
This role provides an exceptional opportunity for healthcare professionals eager to advance their careers while making a significant impact on patient care.
Company Culture And Values
We are proud of our collaborative and team-oriented environment where the commitment to improving patient outcomes is at the heart of our mission. By joining our organization, you become part of a culture that values excellence and innovation in healthcare.
Employment Type: Full-Time
We invite dedicated and compassionate professionals to consider the position of Care Review Clinician I, working remotely within our esteemed healthcare services team. This pivotal role emphasizes collaboration with patients, healthcare providers, and a multidisciplinary team to assess, plan, and coordinate comprehensive care for individuals with intricate healthcare requirements. Your primary mission will be to guarantee that each patient receives optimal care in a timely manner and within the most suitable environment, all while ensuring adherence to cost-effectiveness and compliance with state and federal regulations.
Key Responsibilities
- Evaluate inpatient care services to secure exemplary outcomes while complying with healthcare regulations and guidelines.
- Analyze clinical requests from healthcare providers or patients in accordance with evidence-based guidelines to ascertain the most suitable course of action.
- Review patient benefits, eligibility, and anticipated duration of care for requested treatments and procedures.
- Conduct reviews to identify financial responsibilities for healthcare services, including prior authorization when applicable.
- Ensure that all requests are processed within mandated timelines for operational efficiency.
- Collaborate with medical directors and multidisciplinary teams to present patient cases, facilitating optimal care planning.
- Gather necessary information by reaching out to patients or providers, ensuring informed care decisions.
- Facilitate appropriate referrals to other clinical programs to support ongoing care needs.
- Maintain adherence to established Utilization Management (UM) policies and procedures.
- Strong assessment and analytical capabilities.
- Exceptional communication and interpersonal skills.
- Ability to collaborate effectively within multidisciplinary teams.
- Proficiency in utilizing Electronic Medical Records (EMR) systems.
- Comprehensive understanding of healthcare regulations and guidelines.
- Minimum of one year of experience in Med-Surg (Medical-Surgical) nursing.
- Active California RN or LVN license.
This role provides an exceptional opportunity for healthcare professionals eager to advance their careers while making a significant impact on patient care.
Company Culture And Values
We are proud of our collaborative and team-oriented environment where the commitment to improving patient outcomes is at the heart of our mission. By joining our organization, you become part of a culture that values excellence and innovation in healthcare.
Employment Type: Full-Time
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