DC Licensed Clinical Reviewer

Job Summary

A company is looking for a Clinical Reviewer DC.

Key Responsibilities

• Apply clinical review criteria and guidelines to determine the medical necessity of healthcare services
• Consult with physician/practitioner consultants on cases that do not meet clinical review criteria
• Document utilization review decisions and provide oversight of non-clinical staff activities

Required Qualifications and Education

• Associates degree in a related field
• 3 years of clinical (direct patient care) experience
• Current, active, unrestricted RN licensure for the District of Columbia
• 2 years of utilization review or medical management experience preferred
• 2 years of experience in substance use disorder or behavioral health disorder preferred