Ohio Licensed Clinical Care Reviewer

Job Summary

To support healthcare service authorization, the full-time Ohio Licensed Clinical Care Reviewer will process medical necessity reviews, assist with discharge planning, and monitor care coordination in a remote setting.

Key responsibilities

• Complete prospective, concurrent, and retrospective reviews for various healthcare services
• Engage with care partners to facilitate transitions to appropriate levels of care and communicate quality issues
• Provide guidance to clinical and non-clinical staff while maintaining knowledge of relevant regulations and standards

Required qualifications

• Current, unrestricted Registered Nurse (RN) Licensure in the state of practice
• Associate of Science (A.S) from an accredited registered nursing degree program
• Three years of clinical experience, preferably in med/surgical or emergency acute care
• Experience in Utilization Management/Utilization Review is preferred
• Knowledge of Medicaid, Medicare, or commercial insurance is preferred