Multistate Licensed Clinical Care Reviewer

Job Summary

A company is looking for a Clinical Care Reviewer II - RN - Multistate Licensed.

Key Responsibilities

• Process medical necessity reviews for healthcare service authorization
• Assist with discharge planning and care coordination for members
• Engage with care partners and medical directors to facilitate transitions in care

Required Qualifications, Training, and Education

• Associate of Science (A.S) from an accredited registered nursing (RN) degree program
• Three (3) years of clinical experience required
• Preferred experience in med/surgical, emergency acute clinical care, or home health
• Utilization Management/Utilization Review experience preferred
• Current, unrestricted Registered Nurse (RN) Licensure in state(s) of practice required