Care Review Clinician (RN)

Provides support for clinical member services review assessment processes, verifying services are medically necessary and align with established clinical guidelines, insurance policies, and regulations. Contributes to overarching strategy to provide quality and cost-effective member care.

Requirements

• At least 2 years experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience.
• Registered Nurse (RN) license active and unrestricted in state of practice.
• Ability to prioritize and manage multiple deadlines.
• Excellent organizational, problem-solving and critical-thinking skills.
• Strong written and verbal communication skills.
• Microsoft Office suite/applicable software program(s) proficiency.

Benefits

• Competitive benefits and compensation package.