Registered Nurse Care Coordinator

Job Summary

To improve healthcare outcomes, the full-time Registered Nurse Care Coordinator will perform clinical appeals and medical necessity reviews for inpatient and outpatient services while working remotely.

Key responsibilities

• Conducts medical necessity reviews, including inpatient, concurrent, and retrospective assessments, ensuring compliance with established criteria and policies
• Collaborates with Medical Directors and various departments to ensure appropriate cost-effective care and identifies clinical program opportunities for members
• Documents clinical information accurately and timely, while maintaining a thorough understanding of provider and member contracts and accreditation requirements

Required qualifications

• Bachelor's degree or four years of relevant work experience
• Current State Licensure as a registered nurse
• Three years of clinical experience
• Preferred experience in Utilization Management and the health plan industry