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RN LPN LVN Clinical Reviewer

Company: VirtualVocations
Location: Durham
Posted on: September 21, 2023

Job Description:

A company is looking for a Clinical Reviewer.
Key Responsibilities:

Perform initial evaluation of referral appropriateness for services and review for necessary information
Use clinical expertise to determine if services meet medical necessity for patients
Ensure timely case review and elevation to meet contractual and regulatory requirements

Required Qualifications:

Associate's Degree or Diploma in Nursing/Practical Nursing
Registered Nurse/LPN/LVN with licensure in state(s) of practice
Minimum 1-2 years prior authorization experience for Medicare or Medicare Advantage Home Health
Minimum 2 years in a clinical setting
Strong knowledge of Medicare PDGM and 1-2 years process experience strongly desired

Keywords: VirtualVocations, Durham , RN LPN LVN Clinical Reviewer, Healthcare , Durham, North Carolina

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