Clinical Reviewer Nurse

About the role

Integrated Home Care Services (IHCS) provides a comprehensive Integrated Delivery System in the home setting, offering Durable Medical Equipment (DME), Respiratory, Home Health, and Home Infusion services. Through our select network of Medicare and Medicaid Certified and Accredited providers, we are available 24/7 to meet the needs of our patients with compassion, expertise, and excellence. For more than 30 years, IHCS has been dedicated to improving lives by delivering the highest quality in-home care services. As a trusted market leader in value-based Home Health, Durable Medical Equipment, and Home Infusion Services, we proudly serve more than 2 million lives across the United States and the Commonwealth of Puerto Rico. Our integrated care model is trusted by leading Managed Care Organizations (MCOs), physicians, and healthcare partners because of our commitment to exceptional patient outcomes and coordinated care. At IHCS, our patients are at the heart of everything we do. We believe in creating a culture built on compassion, integrity, collaboration, and innovation. Every team member plays a vital role in fulfilling our mission of enhancing the quality of life for those we serve through Exceptional Customer Service, Proven Outcomes, and Seamless Care.

Responsibilities

• Ensure that home health care services are administered with quality, cost efficiency, and within compliance
• Continuously review and audit patient treatment files to ensure patients won't receive unnecessary procedures, ineffective treatment, or unnecessarily extensive home healthcare
• Concurrent review of patient's clinical information for efficiency
• Ongoing review of precertification requests for medical necessity
• Coordinate patient care needs with a multi-disciplinary healthcare team
• Maintain accurate records of all patient related interactions
• Ability to stay organized and interact well with others in any situation
• Provide updates to Manager of Utilization Management for review

Qualifications

• State licensure as a LPN or RN
• Minimum 2 years of prior experience in Utilization Management
• Strong knowledge of word processing and spreadsheet computer programs

Skills

• Utilization Management or Case Management certification preferred

Benefits

• Medical, Vision, Dental
• Short- and Long-term insurance
• 6+ Days of Holidays Pay
• PTO
• Employer paid life insurance
• 401K with employer contribution
• Wellness program with reward incentives
• Employee recognition and reward programs
• Comprehensive paid training program