Indiana Licensed Clinical Reviewer

Job Summary

A company is looking for a Clinical Reviewer - LPN/LVN (Remote U.S.) 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 departmental demands
• Serve as a liaison for customer service issues and assist in quality monitoring activities

Required Qualifications

• Active, unrestricted LPN/LVN license in Indiana or a Compact state
• Minimum of a diploma or certificate in Practical Nursing
• 3+ years of clinical experience in acute, behavioral health, or med-surgical environments
• 2+ years of experience in Utilization Review/Management and knowledge of medical necessity review
• 1+ years of knowledge of InterQual criteria and/or Milliman Care Guidelines