Job Summary
A company is looking for a Behavior Health RN Clinical Care Reviewer II.
Key Responsibilities
- Process medical necessity reviews for healthcare service authorization and coordinate care for members
- Facilitate discharge planning and ensure timely transitions to appropriate care levels
- Monitor healthcare service delivery and refer quality issues to Quality Improvement
Required Qualifications, Training, and Education
- Completion of an accredited registered nursing (RN) degree program
- Minimum of three (3) years of clinical behavioral health experience
- Preferred experience in med/surgical, emergency acute clinical care, or home health
- Current, unrestricted Registered Nurse (RN) Licensure in state(s) of practice
- MCG Certification required within six (6) months of hire
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