Indiana Licensed Clinical Reviewer

A company is looking for a Clinical Reviewer. Key Responsibilities Review medical records against criteria, contract requirements, and regulatory standards Assess and manage daily workload and queues while ensuring compliance with quality standards Act as a liaison for customer service issues and maintain professional relationships with internal and external stakeholders Required Qualifications Active unrestricted LPN or RN license in Indiana or a Compact clinical license 5+ years of clinical experience in an acute, behavioral health, or med-surgical environment 2+ years of experience in Utilization Review/Management (UR/UM) or Prior Authorization 2+ years of knowledge of medical necessity review and InterQual criteria or Milliman Care Guidelines (MCG) Proficient in navigating multiple systems effectively

May 23, 2025 - 23:20

A company is looking for a Clinical Reviewer. Key Responsibilities Review medical records against criteria, contract requirements, and regulatory standards Assess and manage daily workload and queues while ensuring compliance with quality standards Act as a liaison for customer service issues and maintain professional relationships with internal and external stakeholders Required Qualifications Active unrestricted LPN or RN license in Indiana or a Compact clinical license 5+ years of clinical experience in an acute, behavioral health, or med-surgical environment 2+ years of experience in Utilization Review/Management (UR/UM) or Prior Authorization 2+ years of knowledge of medical necessity review and InterQual criteria or Milliman Care Guidelines (MCG) Proficient in navigating multiple systems effectively