Medical Reviewer

• Conduct utilization reviews up to and including the appeal level. This includes chart screen, completing electronic worksheets, entering the required information, and making level one denial decisions when necessary.
• Conduct quality and clinical study data collection reviews. This includes a chart review, complete detailed electronic data worksheets.
• Act as a resource for the administrative staff in training, problem-solving, and clarifying procedures. Will provide technical assistance and conduct/participate in staff huddles.
• Participate in collaborative training specific to clinical study objectives.
• Other activities as may be deemed necessary.

Registered Nurse Clinical Reviewer

• Conduct reviews up to and including the appeal level. This includes chart screen, compiling regulatory guidance, researching insurer requirements, completing electronic worksheets, and preparing final determinations.
• Act as a resource for the administrative and clinical staff in training, problem-solving, and clarifying determinations. Will provide technical assistance and conduct/participate in staff huddles.
• Participate in collaborative training
• Other activities as may be deemed necessary

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Registered Nurse Clinical Reviewer

RN Clinical Reviewer – IDR