New York Licensed Care Review Clinician

A company is looking for a Care Review Clinician I. Key Responsibilities Conduct all UM standard Inpatient, Outpatient, and Custodial Care clinical reviews for MLTC members Provide verbal notifications for denials/partial denials to members and providers, and manage personal queues Participate in interdepartmental collaboration and maintain department productivity and quality measures Required Qualifications 1-2 years of experience in Utilization Management (UM) Active, unrestricted NY State Licensed Practical Nurse (LPN) license Completion of an accredited Registered Nursing program or equivalent experience Experience with clinical reviews, processing denials, and knowledge of Medicaid/Medicare guidelines Familiarity with Interqual and other medical necessity determination references

Mar 11, 2025 - 22:53

A company is looking for a Care Review Clinician I. Key Responsibilities Conduct all UM standard Inpatient, Outpatient, and Custodial Care clinical reviews for MLTC members Provide verbal notifications for denials/partial denials to members and providers, and manage personal queues Participate in interdepartmental collaboration and maintain department productivity and quality measures Required Qualifications 1-2 years of experience in Utilization Management (UM) Active, unrestricted NY State Licensed Practical Nurse (LPN) license Completion of an accredited Registered Nursing program or equivalent experience Experience with clinical reviews, processing denials, and knowledge of Medicaid/Medicare guidelines Familiarity with Interqual and other medical necessity determination references