Indiana Licensed Clinical Care Reviewer

Job Summary

To support healthcare service authorization, the full-time Indiana Licensed Clinical Care Reviewer will process medical necessity reviews, assist with discharge planning, and coordinate care for members in a remote setting.

Key responsibilities

• Complete various types of medical reviews, including acute inpatient and outpatient procedures
• Engage with care partners and medical directors to facilitate transitions to appropriate care levels
• Identify quality issues and refer members for Care Management as needed

Required qualifications

• Current, unrestricted Registered Nurse (RN) Licensure in Indiana or MSL required
• Completion of an accredited registered nursing (RN) degree program
• Three years of clinical experience required, preferably in med/surgical or emergency acute care
• Utilization Management/Utilization Review experience preferred
• MCG Certification must be obtained within six months of hire