RN Musculoskeletal Review Nurse

Job Summary

A company is looking for a RN MSK Preservice Review Nurse Remote.

Key Responsibilities

• Review Musculoskeletal (MSK) care requests to assess medical necessity and refer to Medical Directors when necessary
• Evaluate documentation to support medical necessity and determine appropriateness of inpatient and outpatient services
• Maintain communication with all parties involved in case management and adhere to documentation and performance guidelines

Required Qualifications

• Associates, Bachelors, or equivalent in Nursing
• Current and active unrestricted Nursing License or certification
• 3+ years of experience, including 1+ years in Musculoskeletal or Pre-Authorization related roles
• Knowledge of clinical criteria (e.g., CMS, InterQual, etc.)
• Proficiency in operating computers