Clinical Program Nurse II

Job Description
Responsible for reviewing medical information to determine if requested treatment is medically necessary and appropriate according to the given standards.
Responsibilities
Evaluation of Medical Information
Analyzes medical information and applies established criterion to facilitate the utilization review process.
Collaborates objectively with peer physicians to facilitate case resolution.
Utilizes appropriate resources to perform utilization review process.
Documents pertinent information in internal and external communications to support utilization management determinations and case resolutions.
Adheres to the given standard operating procedures (SOP) and turnaround time to complete the review process.
Demonstrates knowledge and understanding of Broadspire medical department policies and procedures and ability to communicate same with internal/ external customers as necessary.
Business Process Support
Plans and organizes individual cas...