Registered Nurse Care Reviewer

Job Summary

Registered Nurse Care Reviewer, responsible for assessing clinical service requests to ensure medical necessity and compliance with guidelines, working full-time in a healthcare setting.

Key Responsibilities

• Assess services for members to ensure optimum outcomes and compliance with regulations
• Analyze clinical service requests against evidence-based clinical 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 the state of practice
• Ability to prioritize and manage multiple deadlines
• Proficiency in Microsoft Office suite and applicable software programs