State Licensed Clinical Reviewer

Job Summary

A company is looking for a Lead Clinical Reviewer.

Key Responsibilities

• Manage clinical cases and assist in coaching and training team members
• Evaluate referral appropriateness and make authorization decisions based on medical necessity
• Participate in utilization management activities and contribute to quality audits

Required Qualifications

• Associate's Degree or Diploma in Nursing/Practical Nursing or equivalent
• Registered Nurse/LPN/LVN license in any state or jurisdiction in the U.S
• Minimum of 2 years clinical experience in a clinical setting
• Expertise in Utilization Management and knowledge of URAC standards
• At least 1 year of Utilization Management experience required