Remote IP CRC – RN – Nebraska

Job Overview

  • Clinical License RN
  • State(s) NE

Full job description

Job Title: IP CRC – RN – Nebraska

Job Description: Inpatient reviews. Reviewer will be expected to do IP reviews. Will be using MCG criteria. Reviewer will need to be comfortable using multiple systems to do a review. Reviewer will need to have IP experience, will need to be able to review medical records to determine if review meets medical necessity.

Must Have Skills: Reviewer needs to be familiar with clinical notes. Needs to be familiar with Outlook, Microsoft teams, Excel and Microsoft word to do reviews. Needs to have the ability to do quality reviews in a timely manner.

Day to Day Responsibilities: Jobs hours are 8:00am – 5:00pm daily Monday – Friday.
No overtime planned at this time.

Expectation is to be to work on time, one hour lunch. Reviews will work off of an assignment sheet and will be expected to meet turnaround times for reviews.

Required Years of Experience: Expectation is 3-5 years of experience. Would prefer to have MCO experience in the UM department.
Required Licensure / Education: RN, License in NE. Prefer reviewer to be residing in NEBRASKA

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 Members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.

Essential Functions:

Provides concurrent review and prior authorizations (as needed) according to policy for members as part of the Utilization Management team.

Identifies appropriate benefits, eligibility, and expected length of stay for members requesting treatments and/or procedures.

Participates in interdepartmental integration and collaboration to enhance the continuity of care for members including Behavioral Health and Long-Term Care.

Maintains department productivity and quality measures.

Attends regular staff meetings.

Assists with mentoring of new team members.

Completes assigned work plan objectives and projects on a timely basis.

Maintains professional relationships with provider community and internal and external customers.

Conducts self in a professional manner at all times.

Maintains cooperative and effective workplace relationships and adheres to company Code of Conduct.

Consults with and refers cases to medical directors regularly, as necessary.

Complies with required workplace safety standards.

Knowledge/Skills/Abilities:

Demonstrated ability to communicate, problem solve, and work effectively with people.

Excellent organizational skill with the ability to manage multiple priorities.

Work independently and handle multiple projects simultaneously.

Knowledge of applicable state, and federal regulations.

In depth knowledge of InterQual and other references for length of stay and medical necessity determinations.

Experience with NCQA.

For immediate consideration:

Kimberly Cameron, PHR

kcameron@anchorstaffing.com

773-881-5743

Job Types: Full-time, Contract

Pay: $43.00 – $46.00 per hour

Expected hours: 40 per week

Benefits:

  • 401(k)
  • Dental insurance
  • Health insurance
  • Paid time off
  • Vision insurance

Standard shift:

  • Day shift

Weekly schedule:

  • Monday to Friday

Experience:

  • Nursing: 3 years (Required)

License/Certification:

  • RN License (Required)

Location:

  • Nebraska (Required)

Work Location: Remote

 

 

 

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