Clinical Reviewer (LPN, LVN, RN)

Job Summary

To support a growing team, the full-time remote Clinical Reviewer (LPN, LVN, RN) will review medical records against established criteria to determine medical appropriateness while managing daily workloads and collaborating on quality improvement initiatives.

Key responsibilities

• Assures accuracy and timeliness of medical record reviews within contract requirements
• Evaluates and adjusts daily workload to meet departmental demands and collaborates on quality monitoring activities
• Functions as a liaison for provider customer service issues and maintains current knowledge of review processes

Required qualifications

• Active, unrestricted LPN, LVN, or RN license from the state of residence
• Associate's degree or practical/vocational nursing diploma or nursing certificate program
• Medical record abstracting skills, including knowledge of medical terminology and disease processes
• Strong clinical assessment and critical thinking skills
• Availability to work Monday-Friday, including occasional evening shifts as assigned