Reviewing clinical documentation and managing authorization requests, the full-time Nursing Graduate Clinical Specialist will work remotely to ensure accuracy and compliance while meeting productivity targets in a structured environment. Key responsibilities Review clinical documentation for completeness and medical necessity to support authorization and utilization review workflows Apply clinical judgment to prior authorization requests while adhering to established review criteria Document findings and maintain compliance with HIPAA and internal quality standards Required qualifications A completed nursing degree Experience in a healthcare BPO or hybrid clinical-operations role Familiarity with EHR/EMR systems and payer portals Ability to navigate high-volume queues and meet productivity expectations Understanding of HIPAA and payer requirements
Clinical Nurse in workfromhome at Unknown Company
This position is listed as full time and able to be worked remotely.