Nurse Clinical Reviewer at TEKsystems in Meridian, Idaho, United States Job Description Job Title: Nurse Clinical ReviewerJob Description Make clinical decisions using approved and accepted plan policies and criteria. Determine eligibility and benefit coverage according to member and provider contracts. Identify appropriate members for medical or behavioral health case management. Respond to requests for authorization of medications or inpatient procedures and services. Document and report potential quality of care or service issues to leadership. Perform peer to peer audits to assist with consistency of application of business workflows. May provide review according to established criteria for procedural authorization. Perform other duties and responsibilities as assigned. Responsibilities + Make clinical decisions using approved and accepted plan policies and criteria. + Determine eligibility and benefit coverage according to member and provider contracts. + Identify appropriate members for medical or behavioral health case management. + Respond to requests for authorization of medications or inpatient procedures and services. + Document and report potential quality of care or service issues to leadership. + Perform peer to peer audits to assist with consistency of application of business workflows. + Provide review according to established criteria for procedural authorization. + Perform other duties and responsibilities as assigned. Essential Skills + Nursing clinical experience + Clinical review experience + Utilization management + Valid unrestricted Registered Nursing License + Proficiency in nursing documentation software Additional Skills & Qualifications + Associates Degree in Nursing or Bachelors Degree in Nursing + 3-5 years of utilization management and clinical review experience + High degree of verbal and written communication skills + Independent and critical thinking abilities + Ability to handle multiple projects simultaneously + Ability to work well in a team environment Why Work Here? Largest healthcare employer in the state, offering opportunities for career growth and professional development. Work Environment Hybrid work schedule for those in the local area, with the option for remote work for out of state employees. Work hours are based on the Mountain Time Zone. The duration of this role will be 6 months to a year. Job Type & Location This is a Contract position based out of Meridian, ID. Pay and Benefits The pay range for this position is $35.00 - $45.00/hr. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: - Medical, dental & vision- Critical Illness, Accident, and Hospital- 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available- Life Insurance (Voluntary Life & AD&D for the employee and dependents)- Short and long-term disability- Health Spending Account (HSA)- Transportation benefits- Employee Assistance Program- Time Off/Leave (PTO, Vacation or Sick Leave) Workplace Type This is a hybrid position in Meridian,ID. Application Deadline This position is anticipated to close on Feb 21, 2025. About TEKsystems: We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company. The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. To view full details and how to apply, please login or create a Job Seeker account
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