Job Description

Overview: The Clinical Services Review Nurse position works directly with MotivHealth’s Medical Director to perform Utilization Management (UM) and Case Management (CM) functions.

Responsibilities and Duties

• Performs clinical intake and reviews cases according to policies and procedures of MotivHealth
• Collects and enters confidential information ensuring the highest level of confidentiality in all areas
• Reviews clinical information against MotivHealth criteria and follows appropriate workflow
• Maintains written documentation according to MotivHealth’s documentation policy
• Provides quality customer service through interaction with members, providers, administrative staff, and others.
• Business focus demonstrates an understanding of the company’s vision, mission, and strategy
• Creates, encourages, and supports an environment that fosters teamwork, respect, diversity, and cooperation with others
• Adheres to all HIPAA, state and federal regulations pertaining to the clinical programs
• Collaborates with Human Resources to ensure adherence to company policies
• Performs other related duties and projects as assigned

Qualifications

• Graduate of an accredited school of nursing
• Current active unrestricted RN license in a state or territory of the U.S.
• Five years of prior experience in direct clinical care or managed care setting required
• Excellent interpersonal, written and presentation skills, including the ability to handle interactions with facility personnel, providers, members, and various internal departments in a professional manner
• Ability to work in a fast-paced, evolving environment, on-call after hours work may be required
• Ability to utilize critical thinking skills
• Strong interpersonal and communication skills
• Highly motivated, self-starter who works independently using all available resources, policies, and procedures to work effectively and meet required timelines
• Minimum of 2 years of health care or health plan experience
• Knowledge of Microsoft Office and programs including Outlook, PowerPoint, Excel, and Word
• Easily able to adapt to change in a fast-growing company

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