Registered Nurse Clinical Reviewer

Job Summary

A company is looking for a Clinical Care Reviewer II.

Key Responsibilities

• Process medical necessity reviews for healthcare services and coordinate care for members
• Facilitate timely discharge planning and refer cases to Medical Directors as needed
• Document and communicate with healthcare partners to ensure effective care coordination

Required Qualifications, Training, and Education

• Completion of an accredited registered nursing (RN) degree program is required
• Minimum of three (3) years clinical experience is required
• 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