Ohio Licensed Clinical Reviewer II

Job Summary

A company is looking for a Clinical Reviewer II - RN - TRICARE.

Key Responsibilities

• Process medical necessity reviews for various healthcare services and coordinate care for timely discharge planning
• Refer cases to Medical Directors when clinical criteria are not met and document care coordination efforts
• Provide guidance to medical management staff and assist with special projects as requested

Required Qualifications

• 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
• Preferred experience in Utilization Management/Utilization Review and Medicaid/Medicare/Commercial settings
• Current, unrestricted Registered Nurse (RN) Licensure in state(s) of practice