Job Summary
A company that provides home health benefits management services for healthcare providers has a current position open for a Remote Sleep Clinical Reviewer.
Individual must be able to fulfill the following responsibilities:
- Perform an initial evaluation of the referral appropriateness for the company's services
- Request additional clinical information when needed to render a decision and determine next steps
- Use clinical expertise, review clinical information and clinical criteria to determine if the service/device meet medical necessity for the patient
Applicants must meet the following qualifications:
- Associate's Degree or Diploma in Nursing/Practical Nursing
- Registered Nurse/LPN/LVN with Licensure in the state(s) of practice (based on allowable state practice act)
- Active, current and unrestricted license
- 1-2+ years prior authorization experience for Medicare or Medicare Advantage Home Health
- 2+ years in a clinical setting
- Proficient analytical, negotiation, communication, problem solving and decision making skills
