North Carolina Licensed Clinical Specialist RN

Job Summary

Independently assessing medical necessity for various health services, the full-time remote North Carolina Licensed Clinical Specialist RN will conduct utilization reviews, ensure compliance with clinical guidelines, and collaborate with other departments to support consumer treatment needs.

Key responsibilities

• Conduct medical necessity reviews and ensure authorized services meet consumer needs and clinical guidelines
• Monitor adherence to utilization management policies and perform pre-certification, concurrent, and retrospective reviews
• Collaborate with stakeholders and maintain open communication to address performance deviations and consumer concerns

Required qualifications

• Current, active, and unrestricted North Carolina clinical license as a Registered Nurse or compact license
• Graduation from a State accredited school of nursing or an Associate's Degree in Nursing with five years of nursing experience, or a Bachelor's degree in Nursing with three years of nursing experience
• Knowledge of physical health conditions and diagnostic treatment guidelines
• Experience in Utilization Management is preferred
• Proficient in computer use and multiple software programs relevant to nursing and healthcare management