Clinical review role authorizing medical services that meet criteria in a healthcare setting. Facilitating referrals and managing case management processes.
Responsibilities
Performs clinical/medical necessity reviews
Authorizes medical services that meet medical criteria
Facilitates referrals to providers or vendors
Communicates decisions to appropriate persons and documents per UM policy
Reviews patients for multiple diagnoses and refers for case management if needed
Attends and actively participates in department/team process/quality improvement activities
Requirements
2 Years Experience in a medical setting (i.e. office, hospital, SNF, medical clinic etc.)
California Licensed Vocational Nurse (LVN) - CA Board of Vocational Nursing & Psychiatric Technicians -REQUIRED
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