Registered Nurse Clinical Reviewer

Job Summary

A company is looking for a Clinical Review Nurse to assess the medical necessity and appropriateness of treatments for Workers' Compensation claimants.

Key Responsibilities

• Conduct Utilization Review activities to evaluate the medical necessity of patient care
• Document Utilization Review activities accurately in case management systems and communicate determinations to relevant parties
• Coordinate treatment programs while ensuring quality and cost-effectiveness of care

Required Qualifications

• Active unrestricted RN license in a U.S. state or territory, with eligibility for a multistate license
• 5+ years of related experience, including 2+ years in direct clinical care or utilization management
• Bachelor's degree in nursing (BSN) preferred or equivalent work experience
• Certification in case management, pharmacy, rehabilitation nursing, or a related specialty is highly preferred
• Acquisition and maintenance of Insurance License(s) may be required within three to six months of starting the job