Care Review Clinician | Remote | Illinois | Contract

Demonstrated ability to communicate, problem solve, and work effectively with people Assessment, organization, independence, and comfort working with individuals with chronic conditions. Excellent organizational skill with the ability to manage multiple priorities Work independently and handle multiple projects simultaneously Strong analytical skills Knowledge of applicable state, and federal regulations Knowledge of ICD-9, CPT coding and HCPC SSI, Coordination of benefits, and Third-Party Liability programs and integration Familiarity with NCQA standards, state/federal regulations and measurement techniques In depth knowledge of CCA and/or other Case Management tools Ability to take initiative and see tasks to completion Computer skills and experience with Microsoft Office Products Excellent verbal and written communication skills Ability to abide by policies Able to maintain regular attendance based upon agreed schedule Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA) Skilled at establishing and maintaining positive and effective work relationships with coworkers, clients, members, providers and customers. WE CONSIDER IT A BONUS IF YOU ALSO HAVE: 2+ years Medical/Surgical acute hospital care experience. 2+ year Utilization Management experience Active, unrestricted IL State license in good standing, RN Familiarity with Inpatient Medical Necessity and Utilization Management

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