Clinical Reviewer - (Remote)

Descripción del puesto

Essential Duties and Responsibilities: - Review service requests that are typically routine, including admissions, discharges, and continued stays, using established clinical criteria, state and federal policy, and contract requirements; escalate complex or non-standard cases that fall outside defined protocols. - Issue approvals, denials, or recommendations based on contract requirements and standardized decision frameworks. - Identify the need for additional clinical documentation or consulta…