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 regarding service denials Ensure accurate and timely submission of all review-related documents and maintain confidentiality of medical records Required Qualifications Active, unrestricted Registered Nurse (RN) License 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 and medical terminology
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 regarding service denials
Ensure accurate and timely submission of all review-related documents and maintain confidentiality of medical records
Required Qualifications
Active, unrestricted Registered Nurse (RN) License 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 and medical terminology
