RN Clinical Care Reviewer

A company is looking for a Clinical Care Reviewer, Utilization Management, RN. Key Responsibilities Evaluate medical necessity for inpatient and outpatient services in accordance with clinical guidelines and regulatory requirements Collaborate with healthcare providers to facilitate timely authorizations and optimize patient care Analyze medical records and clinical data to ensure compliance with regulatory and payer guidelines Required Qualifications Associate's Degree in Nursing (ASN) required; Bachelor's Degree in Nursing (BSN) preferred An active compact state Registered Nurse (RN) license in good standing required 3+ years of diverse clinical experience in settings such as ICU, ED, or home health care Proficiency in Electronic Medical Record Systems Strong understanding of utilization review processes and regulatory compliance

Mar 24, 2025 - 19:00

A company is looking for a Clinical Care Reviewer, Utilization Management, RN. Key Responsibilities Evaluate medical necessity for inpatient and outpatient services in accordance with clinical guidelines and regulatory requirements Collaborate with healthcare providers to facilitate timely authorizations and optimize patient care Analyze medical records and clinical data to ensure compliance with regulatory and payer guidelines Required Qualifications Associate's Degree in Nursing (ASN) required; Bachelor's Degree in Nursing (BSN) preferred An active compact state Registered Nurse (RN) license in good standing required 3+ years of diverse clinical experience in settings such as ICU, ED, or home health care Proficiency in Electronic Medical Record Systems Strong understanding of utilization review processes and regulatory compliance