Telephonic Registered Nurse Clinical Reviewer – EviCore

Key Highlights

• Know and understand complex case specialties and case reviews.
• Review clinical information submitted by providers to appropriate criteria and standards and makes decision to issue a review determination or to refer to physician review if criteria are not met.
• Maintain current departmental standards related to productivity.
• Train in clinical certification, utilization management, URAC and NCQA principles, policies, and procedures.
• Prepare program correspondence as needed.