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DVA is not associated with this job post. Nurse Reviewer https://lnkd.in/eTCimaBy Your role in our mission Perform prior authorization reviews of admissions, procedures, services, and supplies to determine medical necessity, appropriateness, and reasonableness of care while maintaining production goals and quality standards. Complete medical necessity and level of care reviews for requested services using the appropriate clinical criteria and refer to Medical Directors for review depending on case findings. Function in a clinical telephone queue working with providers to open a case file, gather clinical information, request additional information, apply the appropriate clinical criteria/guideline, policy, and procedure, and utilize the clinical judgment to render a determination. Document decisions and rationale while maintaining pertinent clinical information in various medical management systems Assists management with training new Utilization Review Nurses to include daily monitoring, mentoring, feedback, and education. Maintains current knowledge of clinical criteria guidelines and successfully completes required CEUs to maintain RN license Responsible for attending training and scheduled meetings to enhance skills and working knowledge of clinical policies, procedures, rules, and regulations. Actively cross-trains to perform multiple review types to provide a flexible workforce to meet client needs. #employeeexperience #people #culture #hiring #talent #skills #passion #leadership #hr #humanresources #team #strategy #hrstrategy #business #team #careers #employment #jobs #hiring #job #jobsearch #recruitment #career #work #careers #recruiting #nowhiring #resume #jobhunt #business #jobseekers #jobopening #jobseeker #hiringnow #interview #jobsearching #vacancy #cfbr #education #jobinterview #jobopportunity #employmentopportunities

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