State Licensed Clinical Reviewer

Job Summary

Utilizing clinical expertise in a remote setting, the full-time State Licensed Clinical Reviewer will assess and evaluate review cases, maintain quality standards, and serve as a liaison for provider customer service while ensuring compliance with regulatory requirements.

Key responsibilities

• Assures accuracy and timeliness of review cases in accordance with contract requirements
• Adjusts daily work schedules to meet workload demands and monitors quality improvement activities
• Acts as a resource for nurse reviewers and fosters professional relationships with internal and external customers

Required qualifications

• Bachelor's Degree from an accredited college or university in a related field
• Active, unrestricted LPN or RN license in the applicable state and/or a Compact State license
• 2+ years of clinical experience in a hospital or post-acute environment
• 2+ years of experience in a call center environment
• 1 year of experience in medical record abstracting and UR or Prior Authorization