UM Care Review Clinician

AltaStaff is a staffing agency currently looking for a UM Care Review Clinician I (Behavioral Health) to work with our Managed Care Client!Pay Rate: $41 - 43 hourlySchedule: Monday - Friday: 8am-5pm CST or 9am-6pm CSTThis is a fully remote role but candidates must have a valid LPN or RN licensure in TexasMust have experience in Prior Authorizations and/or Behavioral Health Outpatient ServicesPosition Purpose: Care Review Clinician works with the Utilization Management team primarily responsible for medical necessity/utilization review aimed at providing members with the right care.Completes/reviews Inpatient Authorizations, reviewing faxes that can be 50-100 pages longWill be expected to manage 25-30 cases successfully daily.Should be able to quickly and accurately determine whether the criteria meet medical necessity.Provides daily review and evaluation of members that require hospitalization and/or procedures providing prior authorizations and/or concurrent review.Assesses services for Molina Members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations andguidelines.Provides concurrent review and prior authorizations (as needed) according to Molina policy for Molina members as part of the Utilization Management team.Additional duties assignedEducation/Experience:RN or LPN/LVN License in Texas requiredMust have 2+ years clinical practice experience (hospital, case management, utilization management)Must have 2+ yrs Utilization Management experience; MCG experience preferredMust have experience in one of the following: Prior Authorizations and/or Behavioral Health Outpatient ServicesPrevious experience working using QNXT/UMK2/PEGA preferredWork Environment Requirements:Must be able to lift at least 30lbsMust be able to stand or sit for prolonged periods (85% of the time)Private Secured Internet Connection. No hot spotsConnecting company equipment directly into routers for access may be required.All Job duties and responsibilities are required to be performed at desk work station.Must confirm work environment is safe and secure for work in handling private and sensitive information.Constantly operates a computer and other office equipmentConstantly works indoors in a secluded safe spaceMust have High-speed internet access 25 MBPS minimum; 50 MBPS minimum preferredIf you've applied and would like to view your application status, please visit: https://altastaff.zenople.com/login/ALTAAltaStaff is an Equal Employment Opportunity Employer. We provide equal employment opportunities to all qualified applicants for employment without regard to age, race, color, creed, religion, sex, marital status, national origin, ancestry, citizenship, disability, veteran status, sexual orientation, or any other protected status, in accordance with applicable federal, state, and local laws.