Clinical Care Reviewer UM (RN/LPN)

Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-state area's most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy, and Nursing.

Job Description

Duration: 3 Months+ (Possible Extension)

Our client is looking to hire a Clinical Care Reviewer UM.

• The primary purpose of the job is to:
• Under the direction of the unit Supervisor, the Clinical Care Reviewer is responsible for completing medical necessity reviews.
• Using clinical knowledge and nursing experience, the nurse reviews provider requests for inpatient and outpatient services, working closely with members and providers to collect all information necessary to perform a thorough medical necessity review.
• It is within the nurse’s discretion to send requests for additional information and/or request clarification.
• The nurse will use professional judgment to evaluate the request to ensure that appropriate services are approved and recognize care coordination opportunities, referring those cases as needed.
• The nurse will apply medical health benefit policy and medical management guidelines to authorize services and appropriately identify and refer requests to the Medical Director when guidelines are not met. The nurse will maintain current knowledge of laws, regulations, and policies relevant to the organizational unit’s business and apply clinical judgment accordingly.

Job-Related Experience and Skills

• Registered Nurse graduated from an accredited program.
• Current unrestricted Iowa Registered Nurse license or LPN.
• Valid Driver’s License and reliable automobile transportation for on-site assignments and off-site work activities.

Physical Effort/Working Conditions

• Reasonable accommodations may be made for individuals with disabilities to perform essential functions.
• Primarily works in a climate-controlled office setting. May require driving or commuting to healthcare facilities. Some positions may require significant walking within healthcare facilities.

Qualifications

• 3 or more years of experience in a related clinical setting.
• Registered Nurse or LPN.
• Excellent oral and written communication skills.
• Ability to identify problems and recommend solutions.
• Self-directed with the ability to work independently.
• Excellent time management skills, prioritizing work and meeting deadlines.
• Ability to advocate for member/member family needs.
• Committed to meeting internal and external customer expectations.
• Maintains continuing education to uphold professional licensure.
• Ability to achieve performance results on audits and Peer-to-Peer reviews.

Additional Information

Feel free to share this opportunity with friends or colleagues who might be interested. We offer a referral bonus for successful referrals.