This is a remote position, however employees will be expected to attend in person trainings and meetings from time to time in Long Beach. Therefore resumes that are not local to the area or missing address will be filtered out.
Are you looking to get your foot in the door with a FORTUNE 500, multi-state health care organization located in Long Beach? We arrange for the delivery of health care services and offer health information management solutions to nearly five million individuals and families who receive their care through Medicaid, Medicare and other government-funded programs in fifteen states. The company is experiencing rapid growth as part of their reputation for providing quality service to disadvantaged individuals.
We are looking for a Temp-to-Perm Care Review Clinician. Summary: Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing healthcare 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 healthcare members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.
Required: -Available Immediately
-Must have unrestricted LVN or RN License in California
-Prior experience with medical review criteria in managed care
-Outpatient or inpatient medical necessity review