Clinical Care Reviewer: Utilization & Medical Necessity

Integrated Resources, Inc.; Harrisburg (Dauphin County); On-site; USD 70,000 - 90,000; Full time

Job summary

A leading healthcare organization is seeking a Clinical Care Reviewer to oversee medical necessity reviews. The ideal candidate will possess an active Pennsylvania RN/LPN license with substantial experience in critical care and utilization management. Join a committed team focused on improving patient outcomes while working in a supportive environment.

Qualifications

• 3-5 years’ experience in critical care or ER in an acute environment.
• 2 years’ experience in utilization management preferably in a managed care environment.
• Comfortable using MS Office products.

Responsibilities

• Complete medical necessity reviews using AHC policies.
• Authorize services and refer requests to Medical Director when guidelines are not met.
• Facilitate discharge planning requests.

Skills

Critical thinking

Attention to detail

Communication

Education

Active unrestricted Pennsylvania RN/LPN license

Job description

A leading healthcare organization is seeking a Clinical Care Reviewer to oversee medical necessity reviews. The ideal candidate will possess an active Pennsylvania RN/LPN license with substantial experience in critical care and utilization management. Join a committed team focused on improving patient outcomes while working in a supportive environment.