RN Clinical Care Reviewer: Medical Necessity & Coordination

Integrated Resources Inc.; Des Moines (IA); On-site; USD 60,000 - 80,000; Full time

Job summary

Integrated Resources, Inc. is seeking a Clinical Care Reviewer to perform medical necessity reviews as directed by the unit Supervisor. The role involves using clinical knowledge to evaluate service requests and ensure compliance with medical management guidelines. This position requires a Registered Nurse with 3-5 years of clinical experience, offering a vital opportunity to contribute to care quality and service approval processes.

Qualifications

• 3-5 years of experience in a clinical setting.
• Registered Nurse graduated from an accredited program.
• Valid Driver’s License and reliable transportation.

Responsibilities

• Conduct medical necessity reviews for inpatient and outpatient services.
• Collaborate with providers to collect necessary information.
• Evaluate requests to ensure appropriate services are approved.

Skills

Clinical judgment

Communication

Attention to detail

Education

Registered Nurse

Job description

Integrated Resources, Inc. is seeking a Clinical Care Reviewer to perform medical necessity reviews as directed by the unit Supervisor. The role involves using clinical knowledge to evaluate service requests and ensure compliance with medical management guidelines. This position requires a Registered Nurse with 3-5 years of clinical experience, offering a vital opportunity to contribute to care quality and service approval processes.