[Hiring] Clinical Review Coordinator @Luminare Health

Role Description

This position is responsible for medical necessity reviews in accordance with the client contracts, State, Federal regulations, following the utilization review URAC standards.

• The Clinical Review Coordinator provides claims support which includes post-service medical reviews.

Qualifications

• Active unrestricted Registered Nurse License in the state of residence, issued by a state or territory of the United States
• Minimum of three years of direct clinical care in an acute medical-surgical setting as a Registered Nurse
• Basic knowledge and use of Microsoft Office Products: Word, Excel, Outlook, Power Point

Requirements

• Minimum three years’ experience in direct clinical care or managed care
• Active state Registered Nurse license in good standing
• Prior Utilization Management experience

• Communicate in a positive and effective manner in both oral and written communication
• Read and interpret documents, criteria, instructions, and policy & procedure manuals
• Critical thinking and prioritization of tasks
• Write/create routine correspondence and reports
• Speak effectively with clients, physicians, providers, families in crisis and community agencies as well as co-workers and senior management
• Add, subtract, multiply and divide in all units of measure, using whole numbers, common fractions and decimals; compute rate, ratio and percent
• Apply common sense understanding to carry out instruction furnished in written, oral or diagram form
• Deal with problems involving several concrete variables in standardized situations
• Evaluate problems, develop alternative solutions and identify trends and patterns
• Excellent interpersonal skills
• Perform multiple tasks simultaneously
• Maintain high level of confidentiality, flexibility and willingness to learn new tasks
• Work in a dynamic team-oriented environment
• Work independently with minimal supervision or instruction

Preferred Requirements

• Bachelors of Science in Nursing (BSN)
• Compact nursing license
• Experience working within a TPA
• Experience working the utilization review process
• MCG certification
• CCM certification

EEO Statement

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

Pay Transparency Statement

At Luminare, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for associates.

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

Min to Max Range: $0.00 - $0.00

Exact compensation may vary based on skills, experience, and location.