Clinical Reviewer Nurse

What We Offer

• Competitive compensation package including medical, vision, dental, short- and long-term insurance
• 6+ days of holidays
• Paid time off
• Employer-paid life insurance
• 401K with employer contribution
• Wellness program with reward incentives
• Employee recognition and reward programs
• Comprehensive paid training program

What You Will Be Doing

• Ensure home health care services are administered with quality, cost efficiency, and within compliance
• Review and audit patient treatment files to prevent unnecessary procedures, ineffective treatment, or excessively extensive home healthcare
• Concurrently review patient's clinical information for efficiency
• Ongoing review of precertification requests for medical necessity
• Coordinate patient care needs with a multi-disciplinary healthcare team
• Maintain accurate records of all patient-related interactions
• Provide updates to the Manager of Utilization Management for review

What You Will Come With

• State licensure as a LPN or RN
• Minimum 2 years of prior experience in Utilization Management
• Strong knowledge of word processing and spreadsheet computer programs
• Utilization Management or Case Management certification preferred