Clinical Care Reviewer II - RN - Nevada WFH - Must be Nevada Resident
CareSource(2 months ago)
About this role
Clinical Care Reviewer II supports CareSource members by evaluating medical necessity and ensuring appropriate authorization of healthcare services. The role emphasizes discharge planning assistance and coordination of care within regulatory and plan guidelines to promote safe, cost-effective service delivery. It operates within the CareSource Management Group to support continuity and quality of care.
Required Skills
- Medical Review
- Discharge Planning
- Care Coordination
- Utilization Management
- Documentation
- Data Entry
- Microsoft Office
- Communication
- Time Management
- Decision Making
Qualifications
- Registered Nurse (RN) Degree
- Registered Nurse (RN) License
- MCG Certification
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