Indiana Licensed Clinical Care Reviewer

Job Summary

A company is looking for a Clinical Care Reviewer - RN with a MSL License.

Key Responsibilities

• Process medical necessity reviews for healthcare service authorizations and assist with discharge planning and care coordination
• Engage with care partners and medical directors to facilitate transitions to appropriate levels of care
• Identify quality issues and refer members for care management while providing guidance to clinical and non-clinical staff

Required Qualifications, Training, and Education

• Associates of Science (A.S) in an accredited registered nursing (RN) degree program
• Three (3) years of clinical experience required
• Preferred experience in med/surgical, emergency acute clinical care, or home health
• Current, unrestricted Registered Nurse (RN) Licensure in state(s) of practice
• MCG Certification must be obtained within six (6) months of hire