Remote RN Clinical Reviewer

A company is looking for a Clinical Reviewer - RN (Remote U.S.) to join their team. Key Responsibilities Review and interpret patient records to determine medical necessity and appropriateness of care Initiate referrals to physician consultants and process their decisions, ensuring detailed documentation of denials Ensure accurate and timely submission of all administrative and review-related documents Required Qualifications Active, unrestricted Registered Nurse (RN) License, or an RN compact state license Associate's, 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 process organization

Apr 4, 2025 - 03:17

A company is looking for a Clinical Reviewer - RN (Remote U.S.) to join their team. Key Responsibilities Review and interpret patient records to determine medical necessity and appropriateness of care Initiate referrals to physician consultants and process their decisions, ensuring detailed documentation of denials Ensure accurate and timely submission of all administrative and review-related documents Required Qualifications Active, unrestricted Registered Nurse (RN) License, or an RN compact state license Associate's, 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 process organization