Clinical Review Nurse - Temporary

FlexStaff is seeking a Temporary Clinical Review Nurse for our client, a non-profit healthcare organization providing home and community-based healthcare and services for the elderly. Location: Uniondale Setting: Hybrid (In office/remote work) Pay Rate: $64/hr Schedule: Monday - Friday 8:30 am-5:30 pm (1 hour lunch) Contract Length: Undetermined, potential for Direct Hire Under the direction of the Senior Director of Clinical Review, the Clinical Review Nurse is responsible for complying with the day-to-day operations of the Clinical Review Department. Responsibilities include reviewing, recommending and providing authorization for services requested by providers based on evidence-based medical necessity criteria. The Senior Director of Clinical Review will monitor the Clinical Review Nurse's activities and outcomes, ensuring compliance with established regulatory and contractual requirements. RESPONSIBILITIES: -Processes requests for authorization from in-network providers and communicates in a timely manner when the decision has been made by the Interdisciplinary Team (IDT). -Collects, reviews, and evaluates information necessary to reach prospective, concurrent and retrospective decisions using objective evidence-based clinical criteria. -Suggests alternate care plans, makes recommendations and coordinates with the Provider/IDT for appropriate utilization of services. -Documents case reviews, associated communications, and outcomes in the electronic case file. -Presents cases to the site Physician and/or Medical Director for review and determination. Works closely with the Physician and/or Medical Director to ensure that medical review of specific cases occurs timely and meets standards for decision turnaround times. -Participates in periodic inter-rater reliability testing on medical necessity criteria application. -Recognizes and refers potential quality of care concerns to Quality Management. QUALIFICATIONS: Education: BSN required Experience: -Minimum of three to five (3 - 5+) years' experience in a hospital or home care clinical setting. -Knowledgeable about Medicare and Medicaid guidelines. -Case Management and discharge planning experience is beneficial. -Two to three (2 - 3) years of Utilization Review experience at a Managed Care Organization is preferred. Other: -Proficient in computer programs such as Microsoft Office and Microsoft Excel a plus. -Excellent verbal and written communication skills. -Excellent problem solving and analytical skills. -Accurate attention to detail with strong organizational skills. -Demonstrated ability to manage multiple projects and be flexible. -Able to travel to any of the various locations, as needed. • Additional Salary Detail The salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining a team member's base salary and/or rate, several factors may be considered as applicable (e.g., location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget and internal equity). Apply Job!