Care Review Clinician II

Lancesoft; United States; Remote; USD 54,000 - 77,000; Full time

Job summary

Lancesoft is seeking a Care Review Clinician for a remote 3-month assignment. You will work with the Utilization Management team to review inpatient cases, authorize care, and ensure compliance with state and federal regulations.

The role requires an active RN/LPN/LVN license and 2–4 years of clinical experience. Strong InterQual knowledge, problem-solving, and communication skills are essential. Schedule is 8–5 PST, on a W2 hourly rate of $47.37.

Qualifications

• Excellent communication and coordination skills.
• Strong organizational and multitasking abilities.
• Knowledge of state and federal regulations affecting care.
• Familiarity with InterQual guidelines and NCQA considerations.
• Ability to maintain confidentiality and HIPAA compliance.

Responsibilities

• Provide concurrent review and prior authorizations for behavioral health cases.
• Assess benefits, eligibility, and expected length of stay for treatments.
• Collaborate with other departments to ensure continuity of care.
• Maintain productivity and quality metrics for the department.
• Mentor new team members and participate in staff meetings.
• Refer cases to medical directors as needed and ensure compliance.

Skills

Communication

Organization

Multitasking

Problem-solving

HIPAA compliance

Education

Registered Nursing degree

Job description

Job Summary

Job Title: Care Review Clinician

Location: Remote

Duration: 3 Months

Contract Offered Rate: $47.37 hourly on W2

Schedule: 8-5 M-F PST

Job Description: Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing ***care 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) for Behavioral health cases 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.
• 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.
• 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.

Required Education

Completion of an accredited Registered Nursing program. (a combination of experience and education will be considered in lieu of Registered Nursing degree).

Required Experience

Minimum 2-4 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.