Licensed Clinical Reviewer

Job Summary

Utilizing clinical expertise to review medical records against established criteria, the full-time Licensed Clinical Reviewer will work remotely to ensure accuracy and timeliness in case reviews while maintaining quality monitoring and fostering professional relationships with providers.

Key responsibilities

• Assures accuracy and timeliness of all review cases in accordance with contract requirements
• Assesses and adjusts daily workload to meet departmental demands
• Functions as a liaison for customer service issues and problem resolution

Required qualifications

• Active unrestricted LPN, RN, or Social Worker license required
• For LPN: Associate's degree or Practical nursing diploma as per state requirements
• For RN or SW: Bachelor's Degree from an accredited college or university in a related field
• Minimum of six years of relevant professional experience may substitute for a Bachelor's degree
• Knowledge of medical records, medical terminology, and disease processes preferred