Clinical Reviewer

Job Summary

A company is looking for a Clinical Reviewer (Remote) in the United States.

Key Responsibilities:

• Review and interpret patient records to determine medical necessity and appropriateness of care
• Process physician consultant decisions and ensure accurate documentation
• Maintain medical records confidentiality and attend training sessions as required

Required Qualifications:

• Active unrestricted RN, Social Worker, or other applicable State clinical license
• Graduation from an accredited Diploma, Associates Degree, or Bachelor's Degree Program
• Knowledge of InterQual criteria and current NCQA/URAC standards
• Minimum two years of clinical experience in an acute or med-surgical environment
• Minimum of one year UR and/or Prior Authorization experience