Indiana Licensed Clinical Reviewer

Job Summary

A company is looking for a Clinical Reviewer to join their team.

Key Responsibilities

• Review medical records for accuracy and compliance with contract requirements and regulatory standards
• Manage daily workload and adjust work schedules to meet department demands
• Act as a liaison for customer service issues and ensure effective relationships with internal and external customers

Required Qualifications

• Associate or Bachelor's degree in nursing from an accredited institution
• Active unrestricted LPN or RN license in Indiana or a Compact clinical license
• 5+ years of clinical experience in an acute, behavioral health, or med-surgical setting
• 2+ years of experience in Utilization Review/Management or related fields
• 2+ years of knowledge in medical necessity review and InterQual criteria or Milliman Care Guidelines