RN LPN LVN Clinical Reviewer

Job Summary

A company is looking for a Clinical Reviewer.

Key Responsibilities:

• Perform initial evaluation of referral appropriateness for services and review for necessary information
• Use clinical expertise to determine if services meet medical necessity for patients
• Ensure timely case review and elevation to meet contractual and regulatory requirements

Required Qualifications:

• Associate's Degree or Diploma in Nursing/Practical Nursing
• Registered Nurse/LPN/LVN with licensure in state(s) of practice
• Minimum 1-2 years prior authorization experience for Medicare or Medicare Advantage Home Health
• Minimum 2 years in a clinical setting
• Strong knowledge of Medicare PDGM and 1-2 years process experience strongly desired