RN Clinical Care Reviewer II
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Job Summary
Working remotely in a full-time capacity, the RN Clinical Care Reviewer II will conduct medical necessity reviews for post-acute health care services, assist with discharge planning, and coordinate care for members, ensuring cost-effective delivery of healthcare services.
Key responsibilities:
- Conduct prospective, concurrent, and retrospective reviews of post-acute admissions and related services
- Facilitate timely and cost-effective member discharges to appropriate levels of care
- Document discharge planning needs and communicate with various stakeholders to support coordinated care
Required qualifications:
- Completion of an accredited registered nursing (RN) degree program
- Three (3) years of clinical experience required
- Current, unrestricted Registered Nurse (RN) licensure in state(s) of practice
- MCG Certification required or must be obtained within six (6) months of hire
- Utilization Management/Utilization Review experience preferred
Complete Job Description
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