Licensed Clinical Review Nurse
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Job Summary
Utilizing critical thinking and clinical expertise, the remote Licensed Clinical Review Nurse will perform first-level clinical reviews for medical necessity authorizations and assist in quality improvement projects while thriving in a fast-paced environment.
Key responsibilities
- Perform initial clinical reviews and document recommendations based on clinical guidelines
- Review clinical documentation against standards and relevant treatment guidelines
- Resolve patient care issues by collaborating with community providers and staff
Required qualifications
- Licensed Nurse Practitioner (LPN) or Registered Nurse (RN) required
- Comprehensive knowledge of general nursing theory and practices
- Previous Utilization Management experience preferred but not required
- Knowledge of musculoskeletal surgical procedures, cardiac procedures, or pain management is a plus
- Proficient computer skills, including typing and navigating various programs
Complete Job Description
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