Job Summary
A healthcare company is filling a position for a Remote Utilization Management Clinical Reviewer .
Core Responsibilities Include:
- Performing review for information needed to make a medical necessity determination
- Requesting additional clinical information when needed to render a decision
- Using information and expertise to determine if the service/device meet medical necessity for the patient
Must meet the following requirements for consideration:
- Minimum of 2 years in a clinical setting
- Active, current and unrestricted license
- Associate's Degree or Diploma in Nursing/Practical Nursing
- Registered Nurse/LPN/LVN with Licensure in the state(s) of practice
- Minimum of 1-2 years prior authorization experience for Medicare or Medicare Advantage Home Health