State Licensed Clinical Reviewer Nurse

Job Summary

Working remotely in a full-time capacity, the State Licensed Clinical Reviewer Nurse will evaluate cases for authorization approval, review clinical documentation, and monitor quality of care standards while collaborating with medical staff and Field Medical Directors.

Key responsibilities

• Evaluate cases that do not pass the authorization approval process and promote a supportive team approach
• Review charts and analyze clinical documentation to approve services meeting review criteria
• Communicate with medical office staff regarding approvals and denials, ensuring compliance with NCQA and health plan timeframes

Required qualifications

• Current RN clinical license in good standing in the home state
• Associate or Bachelor's degree in Nursing
• Minimum of 30 hours per week availability with flexible shift options
• Strong interpersonal and communication skills
• Proficient computer skills, including the ability to talk and type simultaneously