Registered Nurse Clinical Reviewer

Job Summary

A company is looking for a Clinical Documentation Review Nurse.

Key Responsibilities

• Review patient charts and documentation against defined coverage criteria
• Utilize internal AI software to enhance review productivity and apply structured processes
• Produce standardized written summaries of review outcomes and meet daily throughput and quality targets

Required Qualifications

• Active RN license (BSN preferred but not required)
• 2+ years of clinical experience or prior utilization review/documentation review experience
• Ability to follow structured workflows and apply rules consistently
• Comfort working in a high-throughput, metrics-driven environment
• DME, Medicare regulations/surgical dressing reviews preferred but not required