Remote Utilization Management Clinical Reviewer
Job Summary
A provider of home health benefits management services is seeking a Remote Utilization Management Clinical Reviewer.
Must be able to:
- Perform an initial evaluation of the referral appropriateness
- Request additional clinical information when needed
- Ensure case review and elevation to complete the determination is rendered
Required Skills:
- Associate's Degree or Diploma in Nursing/Practical Nursing
- Registered Nurse/LPN/LVN with Licensure in the state(s) of practice
- Hold an active, current and unrestricted license
- 2 years in a clinical setting
- 1-2 years prior authorization experience for Medicare or Medicare Advantage Home Health
- Proficient analytical, negotiation, communication, problem solving and decision making skills
COMPLETE JOB DESCRIPTION
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