Nevada Licensed RN Care Reviewer

Job Summary

Providing support for clinical member services review assessment processes, the full-time Nevada Licensed RN Care Reviewer will verify the medical necessity of services, analyze clinical requests, and ensure compliance with guidelines while working remotely during PST time zone hours.

Key responsibilities

• Assess services for members to ensure optimal outcomes and compliance with regulations
• Analyze clinical service requests against evidence-based guidelines
• Conduct reviews for prior authorization and collaborate with multidisciplinary teams

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 Nevada
• Ability to prioritize and manage multiple deadlines effectively
• Proficiency in Microsoft Office suite and applicable software programs
• Strong organizational and critical-thinking skills