Registered Nurse Care Reviewer

Job Summary

Supporting Medicare members during their transition from inpatient care, the full-time remote Registered Nurse Care Reviewer will conduct assessments, verify service necessity, and collaborate with multidisciplinary teams to ensure quality care outcomes.

Key responsibilities

• Assesses services for members to ensure compliance with regulations and optimal outcomes
• Analyzes clinical service requests against evidence-based guidelines to determine prior authorization
• Collaborates with multidisciplinary teams and refers cases to medical directors as necessary

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
• Proficiency in Microsoft Office and applicable software programs
• Ability to prioritize and manage multiple deadlines effectively
• Strong organizational and critical-thinking skills