North Carolina Licensed RN Clinical Specialist

Job Summary

To support the Utilization Management department, the full-time remote North Carolina Licensed RN Clinical Specialist will independently assess medical necessity for various health services, conduct utilization reviews, and ensure compliance with clinical guidelines while residing in North Carolina and traveling for onsite meetings as needed.

Key responsibilities

• Independently conduct medical necessity reviews of service requests to ensure compliance with clinical guidelines
• Monitor consumer treatment through ongoing reviews and coordinate with other departments to address performance standards
• Participate in the integration of Utilization Management functions into the organization's primary mission

Required qualifications

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