Nurse - Clinical Reviewer HealthHelp, Inc.

Job Responsibilities:

- Conducts clinical review of cases that do not meet criteria
- Performs clinical intake and reviews cases according to the policies and procedures of HH
- Collects and enters confidential information ensuring the highest level of confidentiality in all areas
- Refers cases to a Physician Reviewer or the Director of Utilization Management per guidelines
- Maintains written documentation according to HHs documentation policy
- Provides ongoing telephonic education to providers and office staff related to HHs Clinical Review process
- Assists in the orientation and training of new Clinical Reviewers in department procedures, protocols, and administrative tasks when requested
- Assists Director of Utilization Management with execution of QI projects
- Participates and understands scope of responsibility in all ongoing QI Projects

Job Qualifications:

- RN, LPN/ LVN graduate from an accredited school of nursing or radiation therapy
- Current, active RN, LPN/LVN license
- 2 years previous UM/QM experience in a managed care or 3919863acute hospital setting
- Computer proficiency required
- Good organizational skills preferred
- 2-3 years experience in acute care environment.

Location:	Albany, NY United States