Clinical Reviewer - RN/LPN/LVN
Job Description
A company is looking for a Clinical Reviewer - LPN/LVN or RN - Part-Time (Remote U.S.).
Key Responsibilities
• Review and interpret patient records to assess medical necessity and appropriateness of care
• Approve services or refer cases to a physician consultant and process decisions accordingly
• Continuously evaluate the review process for improvement opportunities and implement necessary changes
Required Qualifications
• Active, unrestricted license as a Registered Nurse (RN), Licensed Practical Nurse (LPN), or Licensed Vocational Nurse (LVN)
• Graduation from an accredited nursing program (Diploma, Associate, Bachelor's or higher degree)
• 2+ years of clinical experience in an acute or med-surgical environment
• Familiarity with NCQA and URAC standards
• Proficiency in medical record abstraction and clinical criteria application
Key Responsibilities
- Review and interpret patient records to assess medical necessity and appropriateness of care
- Approve services or refer cases to a physician consultant and process decisions accordingly
- Continuously evaluate the review process for improvement opportunities and implement necessary changes
Qualifications
- Active, unrestricted license as a Registered Nurse (RN), Licensed Practical Nurse (LPN), or Licensed Vocational Nurse (LVN)
- Graduation from an accredited nursing program (Diploma, Associate, Bachelor's or higher degree)
- 2+ years of clinical experience in an acute or med-surgical environment
- Familiarity with NCQA and URAC standards
- Proficiency in medical record abstraction and clinical criteria application
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