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