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Vermont Licensed Clinical Review Nurse
A company is looking for a Clinical Review Registered Nurse. Key Responsibilities: Conduct clinical reviews for prior approval, post-service reviews, and claim requests Determine the adequacy of clinical information and communicate with providers for additional data as needed Perform audits and provide timely reviews for procedure/service appropriateness based on established guidelines Required Qualifications: 5+ years of clinical/hospital experience as a Registered Nurse Compact Nursing License required 2+ years of Utilization Review/Management experience Experience with medical policy and evidence-based guidelines Ability to perform timely case reviews and updates in appropriate systems
A company is looking for a Clinical Review Registered Nurse.
Key Responsibilities:
Conduct clinical reviews for prior approval, post-service reviews, and claim requests
Determine the adequacy of clinical information and communicate with providers for additional data as needed
Perform audits and provide timely reviews for procedure/service appropriateness based on established guidelines
Required Qualifications:
5+ years of clinical/hospital experience as a Registered Nurse
Compact Nursing License required
2+ years of Utilization Review/Management experience
Experience with medical policy and evidence-based guidelines
Ability to perform timely case reviews and updates in appropriate systems