About this role
• Responsible for the review and evaluation of clinical information and documentation. • Reviews documentation and interprets data obtained from clinical records or systems to apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements for member and/or provider issues. • Independently coordinates the clinical resolution with internal/external clinician support as required.
Qualifications for Internal Candidates
• Active PRC - RN License • With at least 2 years Hospital or Bedside Experience