Registered Nurse Clinical Reviewer

Job Summary

A company is looking for a Clinical Care Reviewer II with a BH UM background.

Key Responsibilities

• Process medical necessity reviews for healthcare service authorizations
• Coordinate care and facilitate timely discharge planning
• Refer cases to medical directors when clinical criteria are not met

Required Qualifications, Training, and Education

• Completion of an accredited registered nursing (RN) degree program
• Minimum of three (3) years of clinical experience
• Preferred experience in med/surgical, emergency acute care, or home health
• Preferred medical management experience
• Current, unrestricted RN licensure in state(s) of practice