Fabergent
Clinical Care Reviewer
Des Moines, IA, United States
Sponsorship not specifiedDetected 3287 days ago
Patient Care
About the role
- Applying criteria to inpatient admissions and performing concurrent review functions, identifying discharge planning needs and referral of members to case management.
- Evaluates clinical information submitted by providers against plan review criteria and benefit guidelines.
- Utilizes clinical information to determine if criteria for medical necessity and benefit guidelines are met.
Requirements
- Two years of experience in managed care quality assurance or utilization review.
- RN must have two years of experience in an acute care hospital.
- Utilizes professional judgment to determine if additional information is required, then follows through to obtain additional information prior to making a decision.
Nice to have
- Associates RN degree required, Bachelor's degree preferred.
Skills
- 3 to 5 years or more experience in a related clinical setting
- Active Iowa RN license or LPN
- UM Experience / Waiver Knowledge (Home and community based)
- Position Qualifications/
Benefits
- Health Care Client
Company info
- Supports and carries out our Mission & Values.
Apply directly at Fabergent →Create a free account for alerts like thisView Fabergent immigration profile
This listing is sourced directly from Fabergent's careers page and normalized into a canonical job model.