State Licensed Clinical Care Reviewer

Job Summary

A company is looking for a Clinical Care Reviewer II - UM Marketplace.

Key Responsibilities

• Process medical necessity reviews for healthcare service authorizations and assist with discharge planning activities
• Coordinate care and facilitate timely and cost-effective discharge to appropriate levels of care
• Document and communicate with Health Partners, Care Managers, and Discharge Planners to ensure safe discharge planning and care coordination

Required Qualifications, Training, and Education

• Completion of an accredited registered nursing (RN) degree program is required
• Minimum of three (3) years of clinical experience is required
• Preferred experience in med/surgical, emergency acute clinical care, or home health
• Utilization Management/Utilization Review experience is preferred
• Current, unrestricted Registered Nurse (RN) Licensure in state(s) of practice is required