State Licensed Care Review Clinician
Location: Remote
Compensation: To Be Discussed
Reviewed: Thu, Mar 13, 2025
This job expires in: 26 days
Job Summary
A company is looking for a Care Review Clinician I.
Key Responsibilities
- Conduct prior authorization reviews and assess services for members to ensure compliance with regulations
- Analyze clinical service requests against evidence-based guidelines and identify appropriate benefits and eligibility
- Collaborate with multidisciplinary teams and maintain productivity and quality measures within the department
Required Qualifications
- At least 1 year of utilization management experience in a clinical setting
- Active, unrestricted State Nursing (RN, LVN, LPN) license in good standing
- Completion of an accredited Registered Nursing program or equivalent experience
- Minimum 0-2 years of clinical practice, preferably in hospital nursing, utilization management, or case management
- Experience with QNXT/UMK2/PEGA and knowledge of applicable state and federal regulations preferred
COMPLETE JOB DESCRIPTION
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