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Care Review Clinician

Long Beach, CA

Posted: 07/08/2024 Industry: Healthcare - LPNs & LVNs Job Number: 39000

Job Description

All UM standard/ expedited Inpatient, Outpatient and Custodial Care clinical reviews for MLTC members.

Must Have Skills:
Must have experience in UM, experience with Turnaround Timeframes, good with computer systems and be able to learn a new system, have done clinical reviews and processed denials and partial denial determinations, know MCG and can use it, case presentation for medical reviews, know Medicaid/ Medicare guidelines. Bi-lingual Spanish, Bengali or Mandarin. - PREFERRED

Day to Day Responsibilities:
All UM standard Inpatient, Outpatient and Custodial Care processes and workflows for any requests, verbal notifications for denials/partial denials to both member and provider, participation in IDTs, personal queue management and clinical reviews.

Required Years of Experience:
At least 1-2 years' experience in UM.

Required Licensure / Education:  Licensure required is a NY State License Practical Nurse or Registered Nurse -LPN NY & NY RN

Job Types: Full-time, Contract

Job Requirements

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