State Licensed Clinical ReviewerVirtualVocations • Humble, Texas, United States
State Licensed Clinical Reviewer
VirtualVocations • Humble, Texas, United States
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A company is looking for a Clinical Reviewer to perform Utilization Management and review clinical information for service requests.
Key Responsibilities
Evaluate referral appropriateness for services and determine medical necessity
Request additional clinical information and interact with the Medical Director as needed
Ensure timely case review and maintain knowledge of services and guidelines
Required Qualifications
Associate's Degree or Diploma in Nursing / Practical Nursing
Registered Nurse / LPN / LVN with active licensure in the state(s) of practice
1-2 years prior authorization experience for Medicare or Medicare Advantage Home Health
Minimum of 2 years in a clinical setting
Knowledge of Medicare PDGM and experience with Interqual is desired
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Clinical Reviewer • Humble, Texas, United States
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