RN Care Review Clinician

Job Summary

Supporting Medicare members during their transition from inpatient care, the full-time remote RN Care Review Clinician will manage care assessments, verify medical necessity, and collaborate with multidisciplinary teams to ensure quality outcomes.

Key responsibilities

• Assesses services for members to ensure compliance with regulations and optimal outcomes
• Analyzes clinical service requests against evidence-based guidelines
• Conducts reviews for prior authorization and collaborates with medical directors as needed

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