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Ohio Licensed Clinical Care Reviewer

8/21/2025

Remote

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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