Licensed Nurse Clinical Reviewer

Job Summary

A company is looking for a Clinical Reviewer, Nurse.

Key Responsibilities

• Perform utilization review of outpatient procedures and ancillary services
• Determine medical necessity and appropriateness of services using clinical review criteria
• Collaborate with healthcare providers to facilitate the provision of services throughout the continuum of care

Required Qualifications

• Registered Nurse or Licensed Practical/Vocational Nurse with a current, unrestricted license
• High School Diploma or equivalent required
• Minimum of three years of direct clinical patient care experience
• Minimum of one year of experience with medical management activities in a managed care environment
• Availability for a Monday-Friday schedule, 9:00 AM-6:00 PM PST, with weekend and holiday rotation required