To support clinical member services, the full-time RN Care Review Clinician will work remotely, assessing service requests for medical necessity and compliance while managing a schedule of four 10-hour shifts per week, including weekends. Key responsibilities Assesses services for members to ensure optimal outcomes and compliance with regulations Analyzes clinical service requests against evidence-based clinical guidelines Collaborates with multidisciplinary teams to promote effective care delivery Required qualifications At least 2 years of experience in hospital acute care, inpatient review, or managed care Active and unrestricted Registered Nurse (RN) license in the state of practice Ability to prioritize and manage multiple deadlines effectively Proficiency in Microsoft Office suite and applicable software programs Strong critical-thinking and organizational skills
RN Care Review Clinician • Knoxville, Tennessee, United States
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