Clinical Care Reviewer UM (RN/LPN)

divh2Clinical Care Reviewer UM (RN/LPN)/h2pIntegrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 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./ph3Job Description/h3pDuration: 3 Months+ (Possible Extension)/ppOur client is looking to hire Clinical Care Reviewer UM./ppJob description:/pulliThe primary purpose of the job is to:/li/ululliUnder the direction of the unit Supervisor, the Clinical Care Reviewer is responsible for completing medical necessity reviews./li/ululliUsing 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./li/ululliIt is within the nurses discretion to send requests for additional information and/or request clarification./li/ululliThe nurse will use his/her professional judgment to evaluate the request to ensure that appropriate services are approved and recognize care coordination opportunities and refer those cases as needed./li/ululliThe 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 and understanding of the laws, regulations, and policies that pertain to the organizational units business and uses clinical judgment in their application./li/ulpJob-Related Experience and Skills:/pulliRegistered Nurse graduated from an accredited program./li/ululliCurrent unrestricted Iowa Registered Nurse license or LPN/li/ululliValid Drivers License and reliable automobile transportation for on-site assignments and off-site work related activities./li/ulpPhysical Effort/Working Conditions/pulliReasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the job./li/ululliPrimarily works in a climate controlled office based setting. May require driving or commuting to health care facilities. Some positions may require a large amount of walking within the health care facility/li/ulh3Qualifications/h3ulli3 or more years experience in a related clinical setting./li/ululliRegistered Nurse or LPN/li/ululliExcellent oral and written communication skills./li/ululliAbility to identify problems and recommend solutions./li/ululliSelf-directed/Ability to work independently./li/ululliExcellent decision making skills./li/ululliExcellent time management skills, prioritizing work and meeting timelines./li/ululliAbility to advocate for member/member family needs./li/ululliDedicated to meeting the expectations and requirements of internal and external customers./li/ululliObtains continuing education required to maintain professional licensure./li/ululliAbility to achieve required performance results on all audits and Inter Rater Reliability (Peer to Peer)./li/ul/div

Careers Integrated Resources Inc