Care Review Clinician I

Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing 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.

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 the 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.
Complies with required workplace safety standards.

Required Experience: Minimum 0-2 years of clinical practice. Preferably hospital nursing, utilization management, and/or case management.

Required Licensure/Certification: Active, unrestricted State Nursing (RN, LVN, LPN) license in good standing.