Prominent managed care organization is seeking a Care Review
Clinician II to work in Troy, MI.
This is a three (3) to six (06) month contract position with the
possibility of extension/temp to hire.
Max pay is $40.00/hour.
This position is responsible for provider appeals, utilization
reviews and assisting with denial letters.
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.
Assesses services for Members to ensure optimum outcomes, cost
effectiveness and compliance with all state and federal regulations
Must be an RN (or NP/PA)
Utilization background in either Managed Care of Provider
environment (at least two years)
Experience with appeals highly preferred
Interqual experience a necessity
Other basic computer skills necessary: Microsoft Office, Data
Needs to be a team player and good communicator
We are an equal employment opportunity employer and will consider
all qualified candidates without regard to disability or protected