DC Licensed Clinical Reviewer Lead

Job Summary

A company is looking for a Clinical Reviewer Lead.

Key Responsibilities

• Lead and mentor a team of clinical reviewers, providing training and performance feedback
• Conduct and oversee detailed clinical reviews of medical records and claims for accuracy and compliance
• Collaborate with healthcare providers and internal departments to resolve discrepancies and improve review processes

Required Qualifications

• Bachelor's degree in Nursing, Health Sciences, or a related clinical field
• Active RN licensure
• Minimum of 5 years of clinical review experience within healthcare services
• Strong knowledge of medical terminology, clinical documentation, and healthcare regulations
• Proven leadership experience managing clinical teams or projects