ID: 54254266 Shift: Day 5x8-Hour (08:30 - 17:00) Description: Job Description2YRS - Utilization Review - 40HRS DAYSSHIFT: 5x8 Day 0830 - 1700Hybrid position 2 days a week in the office, and the other days are remote. Initial set up and training will require at least daily in the office for 1-2 weeks. Must have MD license in hand upon submittalLocal Rate within 60 Miles: See AMCerts Req: BLS, MD LicenseSkills Req: Insurance Company, Care Coordination, Concurrent Review, Continue stay reviews, Determine Medical Necessity per Evidence-Based Guidelines Review, Discharge Planning, Pre-Cert Review, Prior Authorizations, Utilize InterQual Criteria, Admission Criteria and Concurrent stay ReviewPreferably experienced in doing pre-authorizations for a health plan.Previous Charge Experience Preferred2 Years Minimum Experience Required; screen if lessMust have 1 prior travel assignment; screen if lessREGULATORY Skills Req: CMS: Centers for Medicare and Medicaid Services, CPT (Current Procedural Terminology) coding and billing, Department of Health, DRG (Diagnosis Related Groups), HEDIS (The Healthcare Effectiveness Data and Information Set) Measures, HIPAA (The Health Insurance Portability and Accountability Act), ICD 10 Coding, NCQA (National Committee for Quality Assurance), OSHA: Occupational Safety and Health AdministrationThe Joint Commission/ Core Measure/National Safety Goals, Worker s CompensationChronic diagnoses (High Risk Pregnancy, Postpartum, DM, CHF, COPD, Asthma, obesity/overweight, All Behavorial Health, etc.)Will need to make calls to enrollees in Washington DC area to complete comprehensive assessments, developing care plans, and ongoing management within the EMR (guiding care/Healthedge).Care plans must be individualized and address Social Determinants of Health (sDOH) needs. Must be able to collaborate with hospitals, physicians, etc. to ensure successful execution of the care plan.Documentation must reflect NCQA and contract requirements / timelines.Enrollees are Medicaid recipients, the most vulnerable population. Must be able and willing to care for Pregnant Persons/Newborns to Geriatric age groups.This facility requires that all employees have the Flu vaccineMay come into contact with Covid Patientsoffice dress code; business casual Modified 4:00:00 AM Account Manager: Terri Castro Account Manager Email: COVID-19 Vaccine: Not Required Flu Vaccine: Required - No Exemptions Submittal Details: Tier2 Travel ComplianceRTO - RTO must be on the submittal and cannot be changed once the profile has been sent to the manager for review. Please ensure all RTO is for the full 13 weeks for each submittal Amount of RTO: Please, no more than 7 days of RTO per 13 week contract - highly preferred. No RTO the first two weeks of an assignment. of jobs in system we can sub CAN ONLY SUBMIT TO 1 MEDSTAR LOCATION Valid State License (required at time of submission): For DC locations Must have DC license in hand, but certain units accept pending (See JD). Will accept later booking date if traveler has applied for DC licensure. For MD Locations Must have compact license or MD license. References Required Two (2) Supervisor references required Local Radius: 60 miles, address must match DL when determining local statusLocal Rule: accepted at lower rate reach out to AM/EC for local ratesReturn Staff Policy If a nurse has held previous employment with Medstar, must be gone for a minimum of 1 year to return as a traveler. Interview: Manager may or may not interview. Traveler must be OK with this. If Traveler has questions, please email the AM. Note: All submittals go to the clinical team for review even if not on Aya Offer are billable up to 4 hours, any additional hours needed for modules are non-billable; average 12 hours on modulesModules are completed pre-start and potentially during orientation, and can vary by specialtyModules are recorded via transcripts Guaranteed Hours: Contract Weeks:91
