State Licensed Clinical Reviewer Nurse

A company is looking for a Surgery Clinical Reviewer, Nurse.

Key Responsibilities

Evaluate cases that do not pass the authorization approval process while promoting a supportive team approach

Review charts and analyze clinical documentation to approve services meeting clinical review criteria

Monitor quality of care standards in the provider network and document all communications with medical office staff

Required Qualifications

Current, unrestricted state licensure as a Registered Nurse

Associate or Bachelor's degree in Nursing

5+ years of clinical experience preferred

Not under current exclusion or sanction by any state or federal health care program

No history of disciplinary or legal action by a state medical board