RN Reviewer - State Licensed
Company: VirtualVocations
Location: Brooklyn
Posted on: February 1, 2025
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Job Description:
A company is looking for an RN Reviewer who will perform medical
necessity reviews and collaborate with various stakeholders to
ensure appropriate care delivery.
Key Responsibilities
Perform medical necessity reviews including inpatient, concurrent,
prior authorization, retrospective, and out of network reviews
Consult with Medical Directors regarding care that does not meet
applicable criteria or medical policies
Document clinical information accurately and maintain compliance
with regulatory requirements
Required Qualifications and Education
Registered Nurse with an active, unencumbered license in the state
of residence
Minimum of 3 years of clinical experience, with required
Utilization Management experience
Experience in acute care and/or post-acute care environments
Bachelor's degree preferred in Nursing, Business, or equivalent
professional work experience
Proficiency in using MCG guidelines and knowledge of NCQA and CMS
standards
Keywords: VirtualVocations, East Orange , RN Reviewer - State Licensed, Healthcare , Brooklyn, New Jersey
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