This role centers on reviewing clinical cases, investigating escalations, and responding to member inquiries in a fully remote virtual care setting. The nurse analyzes medical records, manages concerns from members and internal teams, and follows each case through resolution. It also contributes to quality, safety, and process improvement work across clinical operations.
Key Responsibilities
- Conduct clinical review of requests, escalations, and member concerns.
- Analyze medical records and other case information to support resolution.
- Investigate issues raised by members and internal teams.
- Coordinate follow-up and case closure across clinical operations workflows.
- Participate in quality, safety, and process improvement efforts.
Required
- Active RN or LPN license.
- Experience working in a clinical setting or with clinical review workflows.