California Licensed RN Reviewer

Job Summary

To support a growing healthcare organization, the full-time remote California Licensed RN Reviewer will conduct clinical reviews of enrollment documentation, ensuring accurate and compliant enrollment determinations for prospective participants.

Key responsibilities

• Conduct clinical reviews of Level of Care assessments and enrollment documentation to evaluate participant readiness
• Utilize organizational guidelines and state-specific regulatory requirements to drive consistent enrollment recommendations
• Document review findings and communicate with stakeholders regarding participant readiness and documentation gaps

Required qualifications

• Active, unrestricted Registered Nurse (RN) license in good standing
• Minimum of three (3) years of PACE experience
• Experience in managed care, utilization review, or regulatory healthcare
• Demonstrated ability to review clinical documentation and conduct clinical assessments
• Proficiency in using Excel, Word, and electronic health records