RN Care Review Clinician

Job Summary

Supporting Medicare members, the full-time remote RN Care Review Clinician will assess clinical service requests, verify medical necessity, and ensure compliance with established guidelines while collaborating with multidisciplinary teams.

Key responsibilities

• Assesses services for members to ensure optimum outcomes and compliance with regulations
• Analyzes clinical service requests against evidence-based clinical 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 the state of practice
• Proficiency in Microsoft Office suite and applicable software programs
• Ability to prioritize and manage multiple deadlines effectively
• Strong organizational and critical-thinking skills