Job Description

Reviews and evaluates clinical documentation, handles fax triage, provider calls, and data interpretation in line with clinical criteria and regulatory requirements, while maintaining confidentiality and navigating multiple systems.

• Responsible for the review and evaluation of clinical information and documentation, fax triage and conversion, and provider calls.
• 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
• Protects the confidentiality of member information and adheres to company policies regarding confidentiality
• Data gathering requires navigation through multiple system applications.

Qualifications

• Active PRC - RN License
• With at least 1 year hospital bedside experience

Please refer to job description.