Ohio Licensed Clinical Care Reviewer

Job Summary

A company is looking for a Clinical Care Reviewer II.

Key Responsibilities

• Process medical necessity reviews for various healthcare services and coordinate care for timely discharge planning
• Refer cases to Medical Directors when clinical criteria are not met and maintain knowledge of relevant regulations and standards
• Document and communicate with healthcare partners to ensure safe discharge planning and care coordination

Required Qualifications

• Completion of an accredited registered nursing (RN) degree program
• Minimum of three (3) years of clinical experience
• Preferred experience in med/surgical, emergency acute clinical care, or home health
• Utilization Management/Utilization Review experience is preferred
• Current, unrestricted Registered Nurse (RN) Licensure in state(s) of practice is required