Washington State Licensed Clinical Reviewer RN

Job Summary

Seeking a full-time salaried Washington State Licensed Clinical Reviewer RN, this remote position focuses on conducting clinical reviews to assess the medical necessity and quality of healthcare services while collaborating with clinical teams and ensuring compliance with regulatory standards.

Key responsibilities

• Conduct prospective, concurrent, and retrospective clinical reviews for various healthcare services
• Collaborate with physician consultants and internal teams to ensure accurate and timely clinical evaluations
• Support compliance with Washington L&I contract requirements and contribute to quality improvement initiatives

Required qualifications

• Current, active, unrestricted Registered Nurse (RN) license in the State of Washington
• Minimum of five years of clinical nursing experience providing direct patient care
• Experience in applying clinical judgment to evaluate patient care and treatment plans
• Proficiency with electronic medical records and clinical documentation systems
• Strong clinical assessment and critical-thinking skills