Tennessee Licensed Review Nurse

Job Summary

To support clinical reviews in Women's Health, Gender Dysphoria, and Genetics, the part-time Tennessee Licensed Review Nurse will perform pre-service clinical coverage reviews remotely, utilizing benefit plan documents and clinical guidelines to make informed decisions.

Key responsibilities:

• Perform clinical reviews requiring interpretation of state and federal mandates and clinical information
• Communicate benefit determinations, including coverage guidelines and reimbursement decisions, both verbally and in writing
• Collaborate with Medical Directors and business partners while managing individual and team performance metrics

Required qualifications:

• Active, unrestricted Registered Nurse license through the State of Tennessee
• 3+ years of RN patient care experience
• Proficiency in Microsoft Office Products, including Outlook, Word, and Excel
• Residency in Tennessee