Pain Management Clinical Reviewer RN

Job Summary

A company is looking for a Clinical Reviewer, Nurse, specializing in Pain Management.

Key Responsibilities:

• Evaluate cases that do not pass the authorization approval process and collaborate with call center staff
• Review charts and clinical documentation to approve services meeting review criteria
• Communicate with medical office staff regarding approvals and denials, providing clinical rationale and maintaining documentation

Required Qualifications, Training, and Education:

• Current, unrestricted state licensure as a Registered Nurse
• Associate or Bachelor's degree in Nursing
• 5+ years of clinical experience preferred
• No history of disciplinary or legal action by a state medical board
• Not under current exclusion or sanction by any state or federal health care program