Remote Lead Clinical Reviewer

Job ID: Available for Members

Location: Nationwide

Compensation: To Be Discussed

Staff Reviewed: Tue, May 14, 2019

Job Category: Case Management, Healthcare, Nursing

Telecommute Level: Majority

Travel Requirements: Possible Travel

Employer Type: Employer

Career Level: Experienced

Education Level: Some College

Job Summary

A healthcare company needs applicants for an opening for a Remote Lead Clinical Reviewer.

Candidates will be responsible for the following:

  • Assigning and prioritizing clinical cases for team member review
  • Making on-going authorization decisions for health plans
  • Researching/identifying all potential payer sources and determining the primary payer

Required Skills:

  • Associate's Degree or Diploma in Nursing/Practical Nursing or the equivalent and RN/LPN/LVN license in any state(s) or jurisdiction in the United States
  • Expertise in Utilization Management and knowledge of URAC standards
  • Broad knowledge of health care delivery/managed care regulations, contract terms/stipulations
  • Prior utilization management/review experience, and governmental home health agency regulations
  • At least 1 year Utilization Management experience
  • High level clinical knowledge, communication, customer service and problem solving skills