Alabama Licensed Clinical Reviewer

Job Summary

A company is looking for a Clinical Reviewer - RN (Remote within Alabama).

Key Responsibilities

• Reviews and interprets patient records to determine medical necessity and appropriateness of care
• Processes physician consultant decisions and ensures detailed documentation of denials
• Maintains confidentiality and adheres to HIPAA policies while fostering professional relationships

Required Qualifications

• Active, unrestricted RN license in the state of Alabama
• Must reside and work in Alabama and be in good standing with the Alabama Board of Nursing
• 2+ years of clinical experience in an acute or med-surgical environment
• Must not hold a concurrent working relationship with a Medicaid-enrolled provider