(Archived) RN-Clinical Reviewer

Position: RN Clinical Review Nurse
Location: Bloomington, MN
Shift: Full-time

Job Details

• Reviews and interprets patient records and compares against criteria to determine medical necessity and appropriateness of care; determines if the medical record documentation supports the need for services
• Determines approval or initiates a referral to the physician consultant and processes physician consultant decisions ensuring reason for the denial is described in sufficient detail on correspondence
• Abstracts review related data/information accurately and timely on appropriate review tool by the appropriate means. Accurate and timely submission of all administrative and review related documents to appropriate parties
• Performs ongoing reassessment of review process to offer opportunities for improvement and/or change
• Foster positive and professional relationships and act as liaison with internal and external customers to ensure effective working relationships and team building in order to facilitate the review process
• Responsible for attending training and scheduled meetings and for maintenance and use of current/updated information for review

Requirements

• Active, unrestricted state RN license
• Graduation from an accredited Diploma, Associates or Bachelor's degree program
• Minimum two years of clinical experience in an acute or med-surgical environment
• Minimum of one year UR and/or Prior Authorization or related experience preferred
• Knowledge of InterQual criteria strongly preferred
• Knowledge of current NCQA/URAC standards strongly preferred

Benefits

• Competitive salary commensurate with experience
• Medical/Dental
• Weekly Pay
• Direct Deposit
• Referral Bonuses
• Childcare reimbursement

For immediate consideration please create a profile and submit your resume through our applicant tracking system. Applications with attached resumes will be given first consideration. Visit us online at [Register to View] to learn more about our company and to view additional openings in your area.

About Us: All Medical Personnel is a national leader in healthcare staffing and recognized by Staffing Industry Analysts (SIA) as one of the nation's largest healthcare staffing firms. Our team of seasoned recruiters are experienced in their ability to recruit, screen and place medical professionals for all types of healthcare settings.