Nevada Licensed Clinical Care Reviewer

Job Summary

A company is looking for a Clinical Care Reviewer II - NICU.

Key Responsibilities

• Process medical necessity reviews for healthcare service authorizations
• Coordinate care and facilitate timely discharge planning for members
• Refer cases to medical directors for clinical criteria evaluations

Required Qualifications, Training, and Education

• Completion of an accredited registered nursing (RN) degree program
• Minimum of three (3) years of clinical NICU experience
• MCG Certification required within six (6) months of hire
• Utilization Management/Utilization Review experience preferred
• Medicaid/Medicare/Commercial experience preferred