This role focuses on medical review work for patient cases, using clinical judgment to assess whether services meet medical criteria and support appropriate care decisions. The work is primarily non-bedside and is suited to an RN or LPN with experience reviewing clinical information and collaborating with internal teams.
Key Responsibilities
- Conduct clinical reviews of patient records and supporting documentation.
- Evaluate cases against medical necessity and care criteria.
- Coordinate with internal care management or utilization review teams as needed.
- Document review findings and communicate determinations clearly.
- Use clinical judgment to support appropriate utilization of services.
Required
- Active RN or LPN licensure.
- Clinical nursing experience.
- Ability to review and interpret medical documentation.