Texas Licensed Nurse Reviewer
Job Summary
Seeking a full-time Texas Licensed Nurse Reviewer, the remote position will perform clinical reviews of medical records to assess the necessity and appropriateness of care while maintaining quality and productivity standards.
Key responsibilities
- Reviews and interprets medical records to determine medical necessity and appropriateness of care
- Documents review decisions and supporting rationale accurately and in a timely manner
- Performs prior authorization and retrospective reviews, preparing decision letters as necessary
Required qualifications
- Active, unrestricted RN license in the United States and primary state of residence
- Minimum of 5+ years of clinical experience in an inpatient hospital setting
- Minimum of 2+ years of utilization review or claims auditing experience
- Experience using Milliman or InterQual criteria
- Proficiency in Microsoft Windows and related software applications
Complete Job Description
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