Kentucky Licensed Care Review RN

Job Summary

Kentucky Licensed Care Review RN, responsible for assessing clinical member services and ensuring compliance with medical necessity and guidelines, in a full-time remote role that may require weekend and holiday work.

Key Responsibilities

• Assess services for members to ensure compliance with regulations and optimal outcomes
• Analyze clinical service requests against evidence-based guidelines
• Collaborate with multidisciplinary teams to enhance care delivery

Required Qualifications

• Registered Nurse (RN) with an active and unrestricted license in Kentucky
• Minimum of 2 years of relevant experience in hospital acute care, inpatient review, or managed care
• Ability to prioritize and manage multiple deadlines
• Proficiency in Microsoft Office suite or applicable software programs