Nurse - Clinical Review

Job Responsibilities:

• Performs utilization review of cases to determine medical necessity criteria in accordance with client and governing body policies.
• Collaborates with client personnel to resolve customer concerns and assists Physician Reviewers and Medical Directors as necessary.
• Maintains written documentation and ensures consistency in policy implementation and regulatory compliance.

Qualifications:

• RN, LPN/LVN graduate from an accredited school of nursing with a current, active unrestricted license in a U.S. state or territory.
• Minimum of two years experience in utilization review, case management, or clinical quality improvement.
• Proficient in Microsoft Office and ability to adapt to new healthcare software systems.

Additional Information:

• Start date: 08/03/2026; training schedule first 6 weeks: Monday to Friday, 8:00 AM – 4:30 PM CST; regular schedule after: 10:30 AM – 7:00 PM CST.
• Remote position with base salary of $65,000 (LVN/LPN) or $75,000 (RN) annually, plus potential performance-based bonuses.
• Equal opportunity employer committed to diversity and inclusion.