Compact Licensed Clinical Care Reviewer II
Job Summary
Seeking a full-time remote Compact Licensed Clinical Care Reviewer II, the role involves processing medical necessity reviews, assisting with discharge planning, and coordinating care for members while ensuring compliance with healthcare regulations.
Key responsibilities:
- Complete prospective, concurrent, and retrospective reviews for various healthcare services
- Engage with care partners to facilitate transitions to appropriate care levels and coordinate member care
- Identify quality issues and refer members for Care Management as needed
Required qualifications:
- Associates of Science (A.S) in an accredited registered nursing (RN) degree program
- Current, unrestricted Registered Nurse (RN) Licensure in state(s) of practice
- Three (3) years of clinical experience required
- MCG Certification or willingness to obtain within six (6) months of hire
- Experience in Med/surgical, emergency acute clinical care, or home health preferred
Complete Job Description
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