Clinical Review RN

Job Summary

A company is looking for a Clinical Review RN (Utilization Management) for a remote position.

Key Responsibilities:

• Initiate referrals to ensure appropriate coordination of care
• Assist non-clinical staff in administrative reviews
• Perform comprehensive provider and member appeals, denial interpretation, and UM pre-certifications utilizing medical criteria

Required Qualifications:

• Active Registered Nurse (RN) license in Tennessee or Nurse Licensure Compact Law state
• 3 years of clinical experience
• Proficient in Microsoft Office and knowledge of accreditations
• Ability to work independently and creatively
• Proficient in interpreting benefits and medical policy criteria