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Job Title: Clinical Review Nurse-HYBRID WORK POSITION

Job Description

We are seeking a dedicated Clinical Review Nurse to manage authorization requests from in-network providers and ensure timely communication of decisions made by the Interdisciplinary Team (IDT). The role involves collecting, reviewing, and evaluating information to make informed decisions using objective evidence-based clinical criteria.

Responsibilities

• Coordinate with the Provider/IDT for appropriate utilization of services.

• Document case reviews, associated communications, and outcomes in the electronic case file.

• Present cases to the site Physician and/or Medical Director for review and determination.

• Work closely with the Physician and/or Medical Director to ensure timely medical review and adherence to decision turnaround standards.

• Identify and refer potential quality of care concerns to Quality Management.

• Maintain confidentiality of all information in compliance with State and Federal Law and company policy.

• Identify and communicate system improvements or individual care issues to ensure appropriate care and meet service requirements.

• Perform other duties as assigned.

Essential Skills

• Current New York State license to practice as a Registered Nurse.

• Minimum of three to five (3 - 5+) years’ experience in a hospital or home care clinical setting.

• Knowledgeable about Medicare and Medicaid guidelines.

• Two to three (2 - 3) years of Utilization Review experience at a Managed Care Organization preferred.

• Proficient in computer programs such as Microsoft Office and Microsoft Excel.

• Excellent verbal and written communication skills.

• Ability to travel to any of the CLHC locations, as needed.

Additional Skills & Qualifications

• Experience with discharge planning is beneficial.

• PACE certification is a plus.

• Experience with electronic health records and Microsoft Word.

• Good organizational, observation, communication, and judgment skills.

• Ability to safely maneuver stairs, climb up/down, and walk to access work areas.

• Delegates responsibility appropriately and supervises ancillary personnel to assure quality care and compliance with the care plan.

• Completes, maintains, and submits all required documentation timely and accurately.

• Acts within the scope of the individual’s authority to practice.

• Meets a standardized set of competencies for the specific position description established by the PACE organization before working independently.

Work Environment

Community Health Centers. Hybrid work environment with 1-2 days in the office. Schedule: 8:30AM – 5:30PM.

Pay and Benefits

The pay range for this position is $55.00 - $60.00/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 Uniondale,NY.

Application Deadline

This position is anticipated to close on Feb 20, 2025.

About Actalent

Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.

Diversity, Equity & Inclusion

At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through:

• Hiring diverse talent

• Maintaining an inclusive environment through persistent self-reflection

• Building a culture of care, engagement, and recognition with clear outcomes

• Ensuring growth opportunities for our people

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com (%20actalentaccommodation@actalentservices.com) for other accommodation options.