RN Care Review Clinician

Job Summary

Providing clinical review support for Medicare inpatient utilization management activities, the full-time RN Care Review Clinician will conduct medical necessity reviews, partner with healthcare teams to ensure appropriate care delivery, and maintain regulatory compliance in a remote setting.

Key responsibilities

• Assesses services for members to ensure optimal outcomes and compliance with regulations
• Analyzes clinical service requests against established clinical guidelines
• Collaborates with multidisciplinary teams to promote effective care delivery

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