Palladian’s Coordinated Spine Care (CSC) Program is an integrated approach to the management of muscular skeletal pain that is related to the spine. The CSC Solution improves the assessment and management of muscular skeletal pain from spinal disorders and promotes evidence-based decision making throughout the care cycle by delivering timely, relevant, and scientifically valid information to educate both members and providers from the onset of care.

RN Nurse Reviewer

Under the supervision of the CSC Program Director and Medical Director(s), review and render decisions for procedure/service authorization requests.

Responsibilities include:

• Process authorization requests
• Obtain supporting clinical documentation from providers with appropriate follow-up.
• Conduct medical review to determine medical necessity of elective spinal procedures/services; issue approvals or summarize denials and forward to Medical Director for review
• Communicate decisions to providers and members
• Educate providers regarding clinical practice guidelines and administrative processes
• Participate in on-going training programs to ensure quality performance and compliance with regulations and guidelines

The ideal candidate will have:

• Current unrestricted NYS RN license - required
• Minimum of two (2) years recent and pertinent clinical experience - required
• Utilization Managment experience preferred
• Ability to handle confidential information
• Proficiency using Microsoft Office Suite (Word, Excel, Access)
• Clinical call center experience helpful