• Reviews documentation and evaluates potential quality of care issues based on clinical policies and benefit determinations 
• Considers all documented system information as well as any additional records/data presented to develop a determination or recommendation.
• Condenses complex information into a clear and precise clinical picture while working independently.
• Data gathering requires navigation through multiple system applications.
• Utilizes client systems to build, research and enter member information
• Applies clinical guidelines in determining clinical decisions
• Experience in patient management in clinical setting is a requirement to help with clinical understanding
• Accurately applies review requirements to assure case is reviewed by a practitioner with clinical expertise for the issue at hand.

BACHELOR OF SCIENCE (B.SC) - NURSING