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
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