As a Clinical Reviewer, you will be responsible for the review of clinical information for service requests received and render a medical necessity approval or recommended denial to the Medical Director. You will evaluate information concerning patient care and match those needs with available care options, consistent with CareCentrix guidelines and specific plan payer criteria. You will review referrals for medical necessity and determine approval or elevation to the Medical Director. You will own the case from point of referral to the recommendation for denial, or approval decision. If a request is to be denied, you will complete the denial process in collaboration with the Medical Director; if a request is to be authorized, it will then be sent onto the staffing department for completion when appropriate.
CareCentrix maintains a drug-free workplace in accordance with Florida’s Drug Free Workplace Law.
We are an equal opportunity employer. Employment selection and related decisions are made without regard to age, race, color, national origin, religion, sex, disability, sexual orientation, gender identification, or being a qualified disabled veteran or qualified veteran of the Vietnam era or any other category protected by Federal or State law.