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State Licensed RN Reviewer
A company is looking for an RN Reviewer. Key Responsibilities Perform medical necessity reviews including inpatient, concurrent, prior authorization, and retrospective reviews Consult with Medical Directors on cases that do not meet applicable criteria or medical policies Document clinical information accurately and maintain compliance with accreditation and regulatory requirements Required Qualifications Registered Nurse with an active, unencumbered license in the state of residence Minimum of 3 years of clinical experience, with required Utilization Management experience Experience in acute care and/or post-acute care environments Preferred Bachelor's degree in Nursing, Business, or equivalent professional work experience Proficient user of MCG guidelines and familiarity with NCQA and CMS standards
A company is looking for an RN Reviewer.
Key Responsibilities
Perform medical necessity reviews including inpatient, concurrent, prior authorization, and retrospective reviews
Consult with Medical Directors on cases that do not meet applicable criteria or medical policies
Document clinical information accurately and maintain compliance with accreditation and regulatory requirements
Required Qualifications
Registered Nurse with an active, unencumbered license in the state of residence
Minimum of 3 years of clinical experience, with required Utilization Management experience
Experience in acute care and/or post-acute care environments
Preferred Bachelor's degree in Nursing, Business, or equivalent professional work experience
Proficient user of MCG guidelines and familiarity with NCQA and CMS standards