RN Musculoskeletal Review Nurse

Job Summary

A company is looking for an RN MSK Preservice Review Nurse to work remotely.

Key Responsibilities

• Review Musculoskeletal (MSK) care requests to assess medical necessity and refer to Medical Directors as needed
• Evaluate documentation to support medical necessity and determine appropriateness of inpatient and outpatient services
• Maintain communication with all parties involved in case management and adhere to documentation and performance guidelines

Required Qualifications

• Undergraduate degree or equivalent experience
• Current and active unrestricted Nursing License or certification
• Willingness to work occasional Saturdays if requested
• 3+ years of experience, including 1+ years in Musculoskeletal, Case Management, or Pre-Authorization
• Proven knowledge of clinical criteria (e.g., CMS, InterQual)