Medical Reviewer

• Complete the full spectrum of activities related to Utilization or Quality reviews as assigned
• Utilize review-program knowledge and expertise to conduct clinical-level review
• Support Medical Review Analysts and Physician Consultants to ensure an appropriate and accurate process
• Conduct utilization reviews up to and including the appeal level
• Screen charts, complete electronic worksheets, enter required information, and make level-one denial decisions when necessary
• Conduct quality and clinical study data collection reviews
• Complete chart reviews and detailed electronic data worksheets
• Act as a resource for administrative staff in training, problem-solving, and clarifying procedures
• Provide technical assistance and conduct or participate in staff huddles
• Participate in collaborative training specific to clinical study objectives
• Perform other necessary activities as assigned

Explore Registered Nurse, Clinical Reviewer at Greenlife Healthcare Staffing. Review requirements and application details.