Registered Nurse Clinical Reviewer

Job Summary

A company is looking for a Clinical Reviewer - RN (Remote U.S.) to join their team.

Key Responsibilities:

• Review and interpret patient records to assess medical necessity and appropriateness of care
• Initiate referrals to physician consultants and process their decisions with detailed correspondence
• Ensure timely submission of administrative documents and perform ongoing reassessment of review processes

Required Qualifications:

• Active, unrestricted Registered Nurse (RN) License in any state or RN compact state license
• Associate's or Bachelor's degree (or Diploma) in Nursing
• 2+ years of clinical experience in an acute or med-surgical environment
• 1+ years of experience in Utilization Review (UR), Utilization Management (UM), or Prior Authorization
• 1+ years of knowledge of medical records, medical terminology, and disease processes