Clinical Reviewer LPN - (Remote)

Descripción del puesto

Essential Duties and Responsibilities: - Review requests for services, including admissions, discharges, and continued stays for adherence to clinical criteria, state and federal policy, and contract requirements involving broad clinical complexity and variability; apply subject matter expertise to ensure consistency and drive quality outcomes; and escalate exceptions to policies. - Issue approvals, denials, or recommendations based on contract requirements; ensure quality, consistency, and adh…