Ohio Licensed Clinical Care Reviewer - job 1 of 2

Job Summary

A company is looking for a Clinical Care Reviewer II - RN - MSL.

Key Responsibilities

• Process medical necessity reviews for healthcare services and coordinate care for timely discharges
• Refer cases to Medical Directors when clinical criteria are not met and identify quality issues for improvement
• Document and communicate with health partners to establish safe discharge planning and provide guidance to medical management staff

Required Qualifications, Training, and Education

• Completion of an accredited registered nursing (RN) degree program
• Minimum of three (3) years of clinical experience
• Preferred experience in med/surgical, emergency acute clinical care, or home health
• Utilization Management/Utilization Review experience is preferred
• Current, unrestricted Registered Nurse (RN) Licensure in state(s) of practice is required