Indiana Licensed Clinical Reviewer

Job Summary

A company is looking for a Clinical Reviewer.

Key Responsibilities

• Review medical records against criteria, contract requirements, and regulatory standards
• Assess and manage daily workload and queues while ensuring compliance with quality standards
• Act as a liaison for customer service issues and maintain professional relationships with internal and external stakeholders

Required Qualifications

• 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 environment
• 2+ years of experience in Utilization Review/Management (UR/UM) or Prior Authorization
• 2+ years of knowledge of medical necessity review and InterQual criteria or Milliman Care Guidelines (MCG)
• Proficient in navigating multiple systems effectively