Care Review Clinician I
Apply NowCompany: Integrated Resources Inc.
Location: Atlanta, GA 30349
Description:
Job Title: Care Review Clinician I
Shift:Full-time, Monday-Friday EST hours: 8:00 AM - 4:30 PM or 8:00 AM - 5:00 PM
Position Type: 100% Remote Temporary (90-day assignment)
Pay Rate: $42.01/hr. on w2
Location Requirements: Candidates must reside in one of the following states:
AZ, FL, GA, ID, IA, KY, MI, NE, NM, NY (outside greater NYC), OH, TX, UT, WA (outside greater Seattle), WI
Role Overview:
As part of the Utilization Management team, the RN will support outpatient utilization review activities including prior authorizations and concurrent reviews. The goal is to ensure members receive the right care at the right time in the most appropriate setting. Preference is given to candidates with experience in outpatient care, particularly DME and therapy, and those familiar with Virginia Medicaid.
Key Responsibilities:
Conduct concurrent reviews and prior authorizations according to company policy.
Evaluate member eligibility, benefits, and expected length of stay for procedures/treatments.
Work independently on assigned outpatient cases, ensuring timely turnaround (TAT).
Collaborate with Behavioral Health, Long-Term Care, and Medical Directors for continuity of care.
Maintain productivity, quality, and compliance with regulatory standards.
Participate in staff meetings and support onboarding of new team members.Communicate professionally with internal teams, providers, and members.
Uphold HIPAA compliance and workplace safety standards
Required:
Active, unrestricted RN license (VA or compact state).
Completion of an accredited Registered Nursing program (or equivalent experience/education).
0-2 years of clinical experience (hospital, UM, or case management preferred).
Preferred:
Experience with outpatient services, DME, and therapy.
Familiarity with Virginia Medicaid or other state Medicaid programs.
Knowledge of Interqual criteria and NCQA standards.
Shift:Full-time, Monday-Friday EST hours: 8:00 AM - 4:30 PM or 8:00 AM - 5:00 PM
Position Type: 100% Remote Temporary (90-day assignment)
Pay Rate: $42.01/hr. on w2
Location Requirements: Candidates must reside in one of the following states:
AZ, FL, GA, ID, IA, KY, MI, NE, NM, NY (outside greater NYC), OH, TX, UT, WA (outside greater Seattle), WI
Role Overview:
As part of the Utilization Management team, the RN will support outpatient utilization review activities including prior authorizations and concurrent reviews. The goal is to ensure members receive the right care at the right time in the most appropriate setting. Preference is given to candidates with experience in outpatient care, particularly DME and therapy, and those familiar with Virginia Medicaid.
Key Responsibilities:
Conduct concurrent reviews and prior authorizations according to company policy.
Evaluate member eligibility, benefits, and expected length of stay for procedures/treatments.
Work independently on assigned outpatient cases, ensuring timely turnaround (TAT).
Collaborate with Behavioral Health, Long-Term Care, and Medical Directors for continuity of care.
Maintain productivity, quality, and compliance with regulatory standards.
Participate in staff meetings and support onboarding of new team members.Communicate professionally with internal teams, providers, and members.
Uphold HIPAA compliance and workplace safety standards
Required:
Active, unrestricted RN license (VA or compact state).
Completion of an accredited Registered Nursing program (or equivalent experience/education).
0-2 years of clinical experience (hospital, UM, or case management preferred).
Preferred:
Experience with outpatient services, DME, and therapy.
Familiarity with Virginia Medicaid or other state Medicaid programs.
Knowledge of Interqual criteria and NCQA standards.