RN Clinical Reviewer

Job Summary

A company is looking for a Clinical Reviewer - RN (Remote U.S.) to join their team.

Key Responsibilities

• Review and interpret patient records to determine medical necessity and appropriateness of care
• Initiate referrals to physician consultants and process their decisions regarding service denials
• Ensure accurate and timely submission of all review-related documents and maintain confidentiality of medical records

Required Qualifications

• Active, unrestricted Registered Nurse (RN) License or RN compact state license
• Associate's or Bachelor's degree (or Diploma) in Nursing
• 2+ years of clinical experience in an acute or med-surgical environment
• 1+ years of experience in Utilization Review (UR), Utilization Management (UM), or Prior Authorization
• 1+ years of knowledge of medical records and medical terminology