Clinical Reviewer RN

Job Summary

Evaluating medical records to ensure compliance with clinical guidelines, the full-time Clinical Reviewer RN will work remotely, applying clinical expertise, documenting decisions, and communicating results to stakeholders.

Key responsibilities

• Reviews and analyzes medical records to determine compliance with regulations and standards of care
• Documents coverage and payment decisions while providing education to stakeholders
• Identifies potential fraud, waste, and abuse, and collaborates with peers and leaders on findings

Required qualifications

• Current, active, unrestricted RN license in state of practice
• 2 years of clinical experience
• 1 year of experience with Microsoft Office
• Experience evaluating medical records for compliance with guidelines
• 1 year of experience in utilization review or case management