Job Summary
A company is looking for a Clinical Care Reviewer II - RN - MSL.
Key Responsibilities
- Process medical necessity reviews for healthcare services and coordinate care for timely discharges
- Refer cases to Medical Directors when clinical criteria are not met and identify quality issues for improvement
- Document and communicate with health partners to establish safe discharge planning and provide guidance to medical management staff
Required Qualifications, Training, and Education
- Completion of an accredited registered nursing (RN) degree program
- Minimum of three (3) years of clinical experience
- Preferred experience in med/surgical, emergency acute clinical care, or home health
- Utilization Management/Utilization Review experience is preferred
- Current, unrestricted Registered Nurse (RN) Licensure in state(s) of practice is required
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