Clinical Reviewer, Nurse
Posted 84ds ago
Employment Information
Job Description
Responsible for precertification within RN/LVN/LPN scope at Evolent's health plan partnerships.
Responsibilities:
- Perform precertification and prior approvals within RN/LVN/LPN scope of practice
- Determine medical necessity and appropriateness of services using clinical review criteria
- Accurately document all review determinations
- Expedite care processes through the continuum
- Collaborate with physicians and providers to facilitate provision of services
Requirements:
- Registered Nurse or Licensed Practical/Vocational Nurse with a current, unrestricted license
- High School Diploma or equivalent required
- Minimum of three years of direct clinical patient care
- Minimum of one year of experience with medical management activities in a managed care environment
- Experience with clinical decision-making criteria sets (i.e. Milliman, InterQual) preferred
- Strong interpersonal, oral and written communication skills
- Basic computer skills
Benefits:
- Comprehensive benefits including health insurance benefits
- Work/life balance
- Flexibility to suit work to lives
- Autonomy to get things done
- Diversity and inclusion as core to our business
