at Point32Health in Chicago, Illinois, United States
Job Description
Qualifications – what you need to perform the job
The Clinical Reviewer, Inpatient RN will be expected to have direct experience with licensed clinical criteria sets (such as InterQual or MCG), Point 32 Health proprietary Medical Necessity Guidelines and product specific payment policies. A current unrestricted MA RN license is required.
EDUCATION: (Minimum education & certifications required)
- Registered Nurse with current, unrestricted MA license
- BSN: Preferred
EXPERIENCE: (Years of experience)
- Minimum of three years of clinical nursing experience.
- Minimum 3 years of UM experience, preferably in an inpatient setting or managed care environment
SKILL REQUIREMENTS: (Include interpersonal skills)
- Excellent interpersonal skills to form positive and collaborative relationships.
- Strong communication skills
- Excellent negotiation skills
- Ability to manage tasks to leverage non-clinical resources on team, provides quarterly audits of the non-clinical denial letter team
- Use professional and clinical judgment to identify issues and escalate accordingly to a supervisor and relevant Point 32 Health departments
- Ability to apply nationally recognized standards to support utilization management
- Ability to mentor
- Ability to assume additional responsibilities such as special projects, while managing a case load
- Ability to use a laptop to accurately document utilization management activities adhering to department documentation standards
- Ability to work independently; highly motivated and self–directed with strong time management skills
- flexibility
- Proficiency with or ability to learn technology for initiating and participating in web/system-based communications: webinar, instant messaging, thin client, soft phone, or others
- Proficiency with or ability to learn technology-based programs such as Microsoft Word and Excel; other programs as needed
Compensation & Total Rewards Overview
As part of our comprehensive total rewards program, colleagues are also eligible for variable pay. Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company's sole discretion and may be modified at the Company’s sole discretion, consistent with the law.
Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:
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Medical, dental and vision coverage
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Retirement plans
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Paid time off
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Employer-paid life and disability insurance with additional buy-up coverage options
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Tuition program
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Well-being benefits
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Full suite of benefits to support career development, individual & family health, and financial health
For more details on our total rewards programs, visit https://www.point32health.org/careers/benefits/
Commitment to Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity
Point32Health is committed to making diversity, equity, inclusion, accessibility and health equity part of everything we do—from product design to the workforce driving that innovation. Our Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity team's strategy is deeply connected to our core values and will evolve as the changing nature of work shifts. Programming, events, and an inclusion infrastructure play a role in how we spread cultural awareness, train people leaders on engaging with their teams and provide parameters on how to recruit and retain talented and dynamic talent. We welcome all applicants and qualified individuals, who will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.
