Registered Nurse Clinical Reviewer

Job Summary

A company is looking for a Clinical Care Reviewer II - Post Acute.

Key Responsibilities

• Process medical necessity reviews for healthcare service authorizations
• Coordinate care and facilitate timely discharge planning for members
• Refer cases to Medical Directors when clinical criteria are not met

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 care, or home health
• Utilization Management/Utilization Review experience is preferred
• Current, unrestricted Registered Nurse (RN) Licensure in state(s) of practice