Job Summary
A company that provides executive search and selection consulting is in need of a Remote Nurse Reviewer.
Candidates will be responsible for the following:
- Performing clinical reviews
- Writing up clinical review summaries for medical directors
- Writing responses to providers and members in plain language, and resolve cases within regulatory time frames
Must meet the following requirements for consideration:
- Current RN license in Rhode Island
- 6+ years of experience in a managed care environment with 1+ year of direct experience in utilization review
- Strong written communication skills to communicate clinical appeal outcomes to members and providers
- Knowledge of utilization management and/or the clinical appeals process
