Clinical Reviewer - RN LPN

VirtualVocations
Roanoke, Virginia, United States
Full-time
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A company is looking for a Clinical Reviewer to utilize clinical expertise for medical record reviews and ensure compliance with regulatory standards.

Key ResponsibilitiesReview and interpret patient records to determine medical necessity and appropriateness of careInitiate referrals to physician consultants and process their decisions, ensuring clear communication of outcomesMaintain confidentiality of medical records and adhere to HIPAA policiesRequired Qualifications, Training, and EducationActive unrestricted LPN or RN State and / or Compact State licenseGraduation from an accredited Technical, Diploma, Associate, or Bachelor Degree Nursing ProgramMinimum two years of clinical experience in an acute, med-surgical, post-acute, or rehabilitation environmentMinimum of one year of Utilization Review (UR) and / or Prior Authorization experienceKnowledge of current NCQA / URAC standards

1 day ago
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