A company is looking for a Utilization Review Specialist- Clinical Reviewer.
Key Responsibilities
Provide clinical expertise and act as a liaison between customers, providers, and recipients
Make prior authorization determinations and assist in adjudicating medically complex prior authorizations
Recommend program improvements and support drafting provider manuals and related publications
Required Qualifications
Bachelor's degree or equivalent work experience
Minimum of two years Medicaid or healthcare experience preferred
Active RN or LPN license in the United States
Utilization Review Specialist • Pasadena, Texas, United States