Clinical Care Reviewer - Des Moines, IA

Only for registered members Des Moines, IA, United States

4 days ago

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Job summary

The Clinical Care Reviewer is responsible for conducting timely reviews of all requests for services required to meet medical necessity criteria. They evaluate clinical information submitted by providers against plan review criteria and benefit guidelines.

Responsibilities

  • Evaluates clinical information submitted by providers against plan review criteria and benefit guidelines.
  • Utilizes professional judgment to determine if additional information is required, then follows through to obtain additional information prior to making a decision.

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