Indiana Licensed Clinical Reviewer

Job Summary

A company is looking for a Clinical Reviewer - LPN/LVN or RN - PRN.

Key Responsibilities

• Review medical records for accuracy and compliance with contract requirements
• Manage daily workload and adjust schedules to meet departmental demands
• Collaborate with supervisors on quality monitoring and maintain knowledge of clinical practices

Required Qualifications

• Active, unrestricted LPN/LVN or RN license in Indiana or a Compact state
• Associate's degree or Practical/Professional nursing diploma from an accredited institution
• Minimum of 2+ years of Utilization Review/Management and/or Prior Authorization experience
• Minimum of 1+ years of experience with InterQual criteria and/or Milliman Care Guidelines
• Knowledge of medical records, terminology, and disease processes