Michigan Licensed Clinical Care Reviewer

Job Summary

A company is looking for a Clinical Care Reviewer II responsible for processing medical necessity reviews and coordinating care for members.

Key Responsibilities

• Complete reviews of various healthcare services including inpatient and outpatient procedures
• Coordinate care and facilitate timely discharge to appropriate levels of care
• Document and communicate with healthcare partners to ensure effective care coordination

Required Qualifications

• 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