BCforward
Clinical Care Reviewer
BCforward, Indianapolis, Indiana, us, 46262
Clinical Care Reviewer
BCforward is seeking a highly motivated and experienced Clinical Care Reviewer.
Job Title:
Clinical Care ReviewerLocation: RemoteContract duration:6 monthsPay Range:
$42/Hr to $44/hr on W2Start Date:09/09/2024Please note this is the target date and is subject to change. BCforward will send official notice ahead of a confirmed start date.
Schedule:40 hours per week - Full time, Contract
Job Summary:
Clinical Care Reviewer II is responsible for processing medical necessity reviews for appropriateness of authorization for health care services, assisting with discharge planning activities (i.e. DME, home health services) and care coordination for members enrolled with a client Management Group line of business, as well as monitoring the delivery of healthcare services in a cost effective manner.
Qualifications:
Current, unrestricted Registered Nurse (RN) Licensure in state(s) of practice is required. *Must be licensed in IndianaCompletion of an accredited registered nursing (RN) degree program is requiredMinimum of three (3) years clinical experience is requiredMed/surgical, emergency acute clinical care or home health experience is preferredMedical management experience is preferredMedicaid/Medicare/Commercial experience is preferredBasic data entry skills and internet utilization skillsWorking knowledge of Microsoft Outlook, Word, and ExcelEffective oral and written communication skillsAbility to work independently and within a team environmentAttention to detailFamiliarity of the healthcare fieldProper grammar usage and phone etiquetteTime management and prioritization skillsCustomer service orientedDecision making/problem solving skillStrong organizationa l skillsChange resiliencyDuties and Responsibilities:
Complete prospective, concurrent and retrospective review of acute inpatient admissions, post acute admissions, elective inpatient admissions, outpatient procedures, homecare services and durable medical equipmentCoordinate care and facilitate discharge to an appropriate level of care in a timely and cost-effective mannerRefer cases to client Medical Directors when clinical criterial is not met or case conference is needed/appropriateMaintain knowledge of state and federal regulations governing client, State Contracts and Provider Agreements, benefits, and accreditation standardsIdentify and refer quality issues to Quality ImprovementIdentify and refer appropriate members for Care ManagementDocument, identify and communicate with Health Partners, Care Managers and Discharge Planners to establish safe discharge planning needs and coordination of careProvide guidance to non-clinical medical management staffProvide guidance to and assist with oversight of LPN and LISW medical management staffAttend medical advisement and State Hearing meetings, as requestedAssist Team Leader with special projects or research, as requestedPerform any other job-related instructions, as requested
Benefits:BCforward offers all eligible employees a comprehensive benefits package including, but not limited to major medical, HSA, dental, vision, employer-provided group life, voluntary life insurance, short-term disability, long-term disability, and 401k.
About BCforward:Founded in 1998 on the idea that industry leaders needed a professional service, and workforce management expert, to fuel the development and execution of core business and technology strategies, BCforward is a Black-owned firm providing unique solutions supporting value capture and digital product delivery needs for organizations around the world. Headquartered in Indianapolis, IN with an Offshore Development Center in Hyderabad, India, BCforward's 6,000 consultants support more than 225 clients globally.BCforward champions the power of human potential to help companies transform, accelerate, and scale. Guided by our core values of People-Centric, Optimism, Excellence, Diversity, and Accountability, our professionals have helped our clients achieve their strategic goals for more than 25 years. Our strong culture and clear values have enabled BCforward to become a market leader and best in class place to work.BCforward is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against based on disability.To learn more about how BCforward collects and uses personal information as part of the recruiting process, view our Privacy Notice and CCPA Addendum. As part of the recruitment process, we may ask for you to disclose and provide us with various categories of personal information, including identifiers, professional information, commercial information, education information, and other related information. BCforward will only use this information to complete the recruitment process.This posting is not an offer of employment. All applicants applying for positions in the United States must be legally authorized to work in the United States. The submission of intentionally false or fraudulent information in response to this posting may render the applicant ineligible for the position. Any subsequent offer of employment will be considered employment at-will regardless of the anticipated assignment duration.
Interested candidates please send resume in Word format Please reference job
BCforward is seeking a highly motivated and experienced Clinical Care Reviewer.
Job Title:
Clinical Care ReviewerLocation: RemoteContract duration:6 monthsPay Range:
$42/Hr to $44/hr on W2Start Date:09/09/2024Please note this is the target date and is subject to change. BCforward will send official notice ahead of a confirmed start date.
Schedule:40 hours per week - Full time, Contract
Job Summary:
Clinical Care Reviewer II is responsible for processing medical necessity reviews for appropriateness of authorization for health care services, assisting with discharge planning activities (i.e. DME, home health services) and care coordination for members enrolled with a client Management Group line of business, as well as monitoring the delivery of healthcare services in a cost effective manner.
Qualifications:
Current, unrestricted Registered Nurse (RN) Licensure in state(s) of practice is required. *Must be licensed in IndianaCompletion of an accredited registered nursing (RN) degree program is requiredMinimum of three (3) years clinical experience is requiredMed/surgical, emergency acute clinical care or home health experience is preferredMedical management experience is preferredMedicaid/Medicare/Commercial experience is preferredBasic data entry skills and internet utilization skillsWorking knowledge of Microsoft Outlook, Word, and ExcelEffective oral and written communication skillsAbility to work independently and within a team environmentAttention to detailFamiliarity of the healthcare fieldProper grammar usage and phone etiquetteTime management and prioritization skillsCustomer service orientedDecision making/problem solving skillStrong organizationa l skillsChange resiliencyDuties and Responsibilities:
Complete prospective, concurrent and retrospective review of acute inpatient admissions, post acute admissions, elective inpatient admissions, outpatient procedures, homecare services and durable medical equipmentCoordinate care and facilitate discharge to an appropriate level of care in a timely and cost-effective mannerRefer cases to client Medical Directors when clinical criterial is not met or case conference is needed/appropriateMaintain knowledge of state and federal regulations governing client, State Contracts and Provider Agreements, benefits, and accreditation standardsIdentify and refer quality issues to Quality ImprovementIdentify and refer appropriate members for Care ManagementDocument, identify and communicate with Health Partners, Care Managers and Discharge Planners to establish safe discharge planning needs and coordination of careProvide guidance to non-clinical medical management staffProvide guidance to and assist with oversight of LPN and LISW medical management staffAttend medical advisement and State Hearing meetings, as requestedAssist Team Leader with special projects or research, as requestedPerform any other job-related instructions, as requested
Benefits:BCforward offers all eligible employees a comprehensive benefits package including, but not limited to major medical, HSA, dental, vision, employer-provided group life, voluntary life insurance, short-term disability, long-term disability, and 401k.
About BCforward:Founded in 1998 on the idea that industry leaders needed a professional service, and workforce management expert, to fuel the development and execution of core business and technology strategies, BCforward is a Black-owned firm providing unique solutions supporting value capture and digital product delivery needs for organizations around the world. Headquartered in Indianapolis, IN with an Offshore Development Center in Hyderabad, India, BCforward's 6,000 consultants support more than 225 clients globally.BCforward champions the power of human potential to help companies transform, accelerate, and scale. Guided by our core values of People-Centric, Optimism, Excellence, Diversity, and Accountability, our professionals have helped our clients achieve their strategic goals for more than 25 years. Our strong culture and clear values have enabled BCforward to become a market leader and best in class place to work.BCforward is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against based on disability.To learn more about how BCforward collects and uses personal information as part of the recruiting process, view our Privacy Notice and CCPA Addendum. As part of the recruitment process, we may ask for you to disclose and provide us with various categories of personal information, including identifiers, professional information, commercial information, education information, and other related information. BCforward will only use this information to complete the recruitment process.This posting is not an offer of employment. All applicants applying for positions in the United States must be legally authorized to work in the United States. The submission of intentionally false or fraudulent information in response to this posting may render the applicant ineligible for the position. Any subsequent offer of employment will be considered employment at-will regardless of the anticipated assignment duration.
Interested candidates please send resume in Word format Please reference job