Registered Nurse Care Reviewer

Job Summary

A company is looking for a Care Review Clinician (RN).

Key Responsibilities

• Assesses services for members to ensure optimal outcomes, cost-effectiveness, and compliance with regulations
• Analyzes clinical service requests against evidence-based clinical guidelines
• Conducts reviews to determine prior authorization and financial responsibility for requested treatments

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 the state of practice
• Ability to prioritize and manage multiple deadlines
• Experience with Microsoft Office suite or applicable software programs