Care Review Clinician (RN)

Provides support for clinical member services review assessment processes. Verifies services are medically necessary and align with established clinical guidelines, insurance policies, and regulations.

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 must be 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.