Clinical Utilization Reviewer - Exeter, RI

SUMMARY

The Clinical Utilization Reviewer - Registered Nurse/Licensed Clinician – collects,analyzes, and provides pertinent, timely clinical information includingmedications, to payer sources and external utilization review personnel forauthorization of inpatient stay and services of the initial, concurrent, anddischarge authorizations and reviews which are completed through interactionswith the client's insurance companies during normal business hours including,nights, weekend and holidays as necessary.

ESSENTIAL DUTIES AND RESPONSIBILITIES

·Obtain proper authorization for eachadmitted patient.

·Review and monitor each step of the authorization process toproactively identify and resolve problems.

·Interact with physicians and therapists on an on-going basis to assurepatient assessment and treatment planning are appropriately coordinated togather all clinical information to determine the medical necessity of requestedhea...

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