Clinical Reviewer

CareCentrix

📍 remote, us, remote, us, United States

Full-time Healthcare Diagnosing or Treating Practitioners

Job Description

Overview

Be part of something bigger—make an impact in a growing organization! CareCentrix is committed to making the home the center of patient care.

Clinical Reviewers are responsible for the Utilization Management and review of clinical information for service requests received and to render a medical necessity approval or recommended denial to the Medical Director. As part of this process, you will evaluate information concerning patient care and match those needs with available care options, consistent with CareCentrix guidelines and specific plan payer criteria.

Responsibilities

In this Job, you will:

  • Perform an initial evaluation of the referral appropriateness for CareCentrix services. Review for information needed to make a medical necessity determination.
  • Request additional clinical information when needed to render a decision and determine next steps.
  • Use clin...
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