Clinical Reviewer in Irvine, CA at Parallon

Date Posted: 8/21/2018

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    Irvine, CA
  • Job Type:
  • Experience:
    2 to 3 years
  • Date Posted:
    8/21/2018

Job Description




CLINICAL REVIEW SPECIALIST




JOB DESCRIPTION

  • Performs TAR reviews and completion of TAR requests according to Medi Cal format and deadlines
  • Position is based in office location
  • Performs Medi Cal clinical medical file review of hospital documentation for necessary clinical treatment and patient severity of illness to warrant admissions and continued acute inpatient level of care
  • Performs on line documentation of clinical justification for hospital stays and pre screening of files to determine if Appeal is warranted.
  • Documents clinical justification for Appeal requests
  • Conducts clinical review of cases that do not meet criteria
  • Performs clinical intake and reviews cases according to the policies and procedures of Parallons.
  • Collects and enters confidential information ensuring the highest level of confidentiality in all areas.
  • Maintains written documentation according to Parallon's documentation policy
  • Provides ongoing to TAR related to Parallon's Clinical Review process 
  • Assists in the orientation and training of new clinical TAR staff in department.
  • Participates and understands scope of responsibility in all ongoing of the  TAR Process.
  • Knowledge of care management plans and services in order to implement that knowledge in a clinical in-patient setting.
  • Knowledge of care management plans and services in order to implement that knowledge in a clinical setting.
  • Ability to use independent judgment related to medical record review.

 





Job Requirements



  • LVN from an accredited school of nursing, active California LVN license 
  • 2-3 years’ experience in acute care environment 
  • 3 years previous utilization management experience in a managed care and/or hospital setting Computer proficiency
  • An associate or bachelor's degree in nursing or a hospital-sponsored diploma.
  • Knowledge and proficiency of established clinical standards and guidelines with Medi-Cal
  • Good organizational skills preferred
  • Experience in both nurse review and assisting with the utilization review appeals process.

Salary: $21-23 p/h DOE