UM Clinical Reviewer Job at Centers Plan for Healthy Living, Margate, FL

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  • Centers Plan for Healthy Living
  • Margate, FL

Job Description

The UM Clinical Reviewer will evaluate clinical information to ensure appropriate patient care and adherence to guidelines. This role involves collaboration with healthcare providers and insurance companies to facilitate optimal treatment plans. Responsibilities:

  • Review clinical documentation for medical necessity
  • Collaborate with healthcare teams to assess patient care
  • Provide recommendations based on clinical guidelines
  • Maintain accurate records of reviews and decisions
  • Communicate effectively with providers and stakeholders
Requirements:

  • Active nursing license in Florida
  • Experience in clinical review or utilization management
  • Strong analytical and communication skills
  • Knowledge of healthcare regulations and guidelines
  • Ability to work independently and as part of a team

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