Providing clinical review support on an as-needed basis, the part-time PRN Clinical Review Nurse (RN) will review medical records for medical necessity, authorization compliance, and payer guideline alignment while supporting appeal submissions remotely. Key responsibilities Perform clinical reviews for medical necessity and authorization-related denials Review inpatient and outpatient medical records to support appeal submissions Document review findings accurately in designated systems while collaborating with clinical leadership as needed Required qualifications Active, unrestricted RN license (compact preferred) Minimum 3-5 years of clinical experience, with 2+ years in Utilization Review, Appeals, or Clinical Review Strong knowledge of medical necessity criteria and payer guidelines Experience writing appeals letters and reviewing inpatient/outpatient hospital claims Proficiency with EMRs and review platforms (Epic preferred)
Remote Clinical Review Nurse (RN) in workfromhome at Unknown Company
This position is listed as part time and able to be worked remotely.