Massachusetts Licensed Clinical Reviewer

Job Summary

A company is looking for a LPN/OTA/PTA Clinical Reviewer.

Key Responsibilities

• Conducts timely clinical decision reviews for services requiring prior authorization across various clinical areas
• Applies established criteria to interpret clinical guidelines and determine medical necessity of services
• Communicates review results to relevant parties and ensures compliance with regulatory and contractual requirements

Required Qualifications

• Associates Degree
• Current Massachusetts LPN, OTA, or PTA clinical license in good standing
• 3+ years of combined clinical and utilization management/care management experience
• Home Health experience
• Experience working in a health plan and/or with a care management platform is a strong plus