Job Summary
A home health benefits management service provider has an open position for a Telecommute Clinical Reviewer.
Individual must be able to fulfill the following responsibilities:
- Perform an initial evaluation of the referral appropriateness for CareCentrix services
- Request additional clinical information when needed to render a decision and determine next steps
- Interact with the Medical Director as needed to ensure proper medical necessity decisions are being made
Must meet the following requirements for consideration:
- Have an Associate's Degree or Diploma in Nursing/Practical Nursing
- Are a Registered Nurse/LPN/LVN with Licensure in the state(s) of practice
- Hold an active, current and unrestricted license
- Have a minimum of 2 years in a clinical setting
- Have a minimum of 1-2 years prior authorization experience for Medicare or Medicare Advantage Home Health required