State Licensed Clinical Reviewer Nurse

Job Summary

A company is looking for a Surgery Clinical Reviewer, Nurse.

Key Responsibilities

• Evaluate cases that do not pass the authorization approval process while promoting a supportive team approach
• Review charts and analyze clinical documentation to approve services meeting clinical review criteria
• Monitor quality of care standards in the provider network and document all communications with medical office staff

Required Qualifications

• Current, unrestricted state licensure as a Registered Nurse
• Associate or Bachelor's degree in Nursing
• 5+ years of clinical experience preferred
• Not under current exclusion or sanction by any state or federal health care program
• No history of disciplinary or legal action by a state medical board