Florida Licensed RN Care Reviewer

Job Summary

A company is looking for an RN Care Review Clinician to provide support for clinical member services review assessment processes.

Key Responsibilities

• Assess services for members to ensure optimum outcomes and compliance with regulations
• Analyze clinical service requests against evidence-based clinical guidelines
• Conduct reviews to determine prior authorization and financial responsibility for treatments

Required Qualifications

• At least 2 years of experience in hospital acute care, inpatient review, or managed care
• Active and unrestricted Registered Nurse (RN) license in the state of practice
• Ability to prioritize and manage multiple deadlines
• Proficiency in Microsoft Office suite or applicable software programs