Minnesota Licensed MSK Review Nurse

Job Summary

To support musculoskeletal care requests, the remote Minnesota Licensed MSK Review Nurse will review documentation for medical necessity, determine appropriateness of services, and maintain communication with all parties involved in case management, all while working full-time in a non-exempt role.

Key responsibilities:

• Review Musculoskeletal (MSK) care requests to assess medical necessity and refer to Medical Directors as needed
• Evaluate documentation to support medical necessity and determine appropriateness of inpatient and outpatient services
• Maintain communication with all stakeholders involved in case management and adhere to documentation guidelines

Required qualifications:

• Associates or Bachelor's degree in Nursing or equivalent
• Current and active unrestricted Nursing License or certification
• 3+ years of nursing experience, including 1+ years in Musculoskeletal or Pre-Authorization roles
• Knowledge of clinical criteria (e.g., CMS, InterQual)
• Proficiency in computer applications