Nurse Clinical Reviewer

DescriptionMake clinical decisions using approved and accepted plan policies and criteria. Determine eligibility and benefit coverage according to member and provider contracts. Identify appropriate members for medical or behavioral health case management. Respond to requests for authorization of medications or inpatient procedures and services. Document and reports potential quality of care or service issues to leadership. Perform peer to peer audits to assist with consistency of application of business workflows. May provide review according to established criteria for procedural authorization. Perform other duties and responsibilities as assigned.Skillsnursing clinical, clinical review, nursing documentation softwareTop Skills Detailsnursing clinical,clinical reviewAdditional Skills & QualificationsAssociates Degree in Nursing or Bachelors Degree in Nursing 3-5 years’ utilization management, clinical review experience High degree verbal and written communication Independent and critical thinking Handle multiple projects simultaneously Work well in a team environment Valid unrestricted Registered Nursing LicenseExperience LevelExpert LevelPay and BenefitsThe pay range for this position is $35.00 - $45.00/hr.Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: Medical, dental & vision Critical Illness, Accident, and Hospital 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available Life Insurance (Voluntary Life & AD&D for the employee and dependents) Short and long-term disability Health Spending Account (HSA) Transportation benefits Employee Assistance Program Time Off/Leave (PTO, Vacation or Sick Leave)Workplace TypeThis is a hybrid position in Salt Lake City,UT.Application DeadlineThis position is anticipated to close on Feb 14, 2025.About TEKsystems: We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company. The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.