Care Review Clinician

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 Ability to take initiative and see tasks to completion Computer Literate (Microsoft Office Products) Excellent verbal and written communication skills Ability to abide by policies Ability to maintain attendance to support required quality and quantity of work Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA) Skilled at establishing and maintaining positive and effective work relationships with coworkers, clients, members, providers and customers