Utilization REview Clinician

Interested in joining a fast-growing company with a great work environment, which delivers exemplary clinical services to our clients. We are in search of an experienced RN who is looking for an exciting opportunity to be a part of a rewarding and diversified company culture. Our clinical services encompass performing prospective, concurrent, and retrospective review for a high-volume client.

This position requires the candidate to have strong communication skills both verbal and written as well as expertise in applying medical necessity criteria. Qualified candidates must be able to demonstrate a proven track record of delivering excellent results on key performance indicators. The candidate must be able to function independently with exceptional time management and organizational skills.

The Utilization Review Clinician will be responsible for creating &/or contributing to Client reporting; provides effective Client communication – calls, e-mails, coordination of care; utilizing InterQual® (or other client criteria set) to apply medical necessity criteria; contacting the payer for authorization and conducting medical necessity reviews; documentation of clinical outcomes for prospective, concurrent and retrospective review in client system; and comply with applicable government regulations as it pertains to Utilization Review and related billing.  

Education/Experience:

• Valid registered nursing license
• Minimum of 2 years clinical experience in an acute care setting and
• Minimum of 2 years with 2 plus years of health care revenue cycle experience
• ACM or CCM accreditation a plus

The above statements describe the general nature and level of work being performed as of the date of preparation and approval. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of the position. Employees holding this position will be required to perform any other job-related duties as requested by management. The job description does not constitute an employment agreement between the employer and employee, and all requirements are subject to possible modification to reasonably accommodate individuals with disabilities.