Indiana Licensed Clinical Reviewer

Job Summary

A company is looking for a Clinical Reviewer - LPN/LVN or RN (Remote U.S.).

Key Responsibilities

• Review medical records for accuracy and compliance with contract requirements and regulatory standards
• Assess and manage daily workload, adjusting schedules to meet departmental demands
• Act as a liaison for customer service issues and maintain relationships with internal and external customers

Required Qualifications

• Active, unrestricted LPN/LVN or RN license in the state of Indiana or a Compact state
• 3+ years of clinical experience in an acute, behavioral health, and/or med-surgical environment
• 2+ years of experience in Utilization Review/Management (UR/UM) and/or Prior Authorization
• 1+ years of knowledge of InterQual criteria and/or Milliman Care Guidelines (MCG)
• Proficient in navigating multiple systems effectively