Responsibilities

• Evaluate telephone, fax, or web requests for authorization of clinical services from physician offices and imaging centers.
• Compare requests against established clinical protocols and authorize services or refer requests for expert clinical review as needed.
• Understand complex case specialties and conduct thorough case reviews.
• Review clinical information submitted by providers against appropriate criteria and standards to make determinations.
• Communicate decisions effectively to healthcare providers and clients, ensuring clarity and understanding.
• Maintain accurate and detailed records of all review processes and outcomes.
• Participate in ongoing training and development to stay current with clinical standards and practices.
• Adhere to all regulatory and compliance standards in clinical review processes.

Requirements

• Current and valid Registered Nurse (RN) license.
• Minimum of 2 years clinical nursing experience, preferably in a review or case management setting.
• Strong knowledge of clinical guidelines, protocols, and healthcare regulations.
• Excellent communication and interpersonal skills.
• Proficient in the use of electronic health record systems and telephonic communication tools.
• Ability to work independently and manage time effectively.
• Must be available for training hours, with flexibility for future shifts based on business needs.

Benefits

• Competitive salary and benefits package.
• Flexible work schedule with a remote work option.
• Opportunities for professional development and career advancement.
• Supportive and collaborative work environment.
• Comprehensive health insurance coverage.
• Paid time off and holidays.