Clinical Reviewer RN
US-NJ-Camden
External Career Portal
Req #: 72476
Type: Full Time
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Responsibilities: Utilizes Payer specific screening tools as a resource to assist in the determination process regarding level of service and medical necessity. Performs utilization review in accordance with all state mandated regulations. Consults with Physician Advisor to discuss medical necessity, length of stay, and appropriateness of care issues. Identify and manage concurrent and retroactive denials through communication with attending physicians, case management, multidisciplinary team, external physician resource group and payers. Completes documentation of review and denial processes in the EPIC Case Management Module Responds to requests from the payer for all required information and treatment plans. Reviews and validates physician's orders, reports progress and unusual occurrences on patients to the payer.
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