Registered Nurse Clinical Reviewer

Job Summary

A company is looking for a Clinical Reviewer, Nurse to join their utilization management team in a work-from-home capacity.

Key Responsibilities

• Evaluate cases that do not pass the authorization approval process and promote a supportive team approach
• Review charts and analyze clinical documentation to approve services meeting clinical review criteria
• Communicate with medical office staff regarding approvals and denials, providing clinical rationale and maintaining customer service standards

Required Qualifications

• Current, unrestricted state licensure as a Registered Nurse
• Associate or Bachelor's degree in Nursing preferred
• Availability to work Monday-Friday, 8am-5pm Eastern
• 5+ years of clinical experience preferred
• Proficient computer skills, including the ability to talk and type simultaneously