Clinical Review Nurse

Responsibilities:

• Perform clinical reviews (part A, B, appeals, quality of care) and conduct peer-to-peer discussions.
• Participate in inter-rater reliability activities and acute/post-acute clinical rounds.
• Serve as a clinical resource and subject matter expert to both clinical and non-clinical staff.

Required Skills and Experience:

• Broad state licensure coverage and willingness to obtain additional state licenses.
• Medicare Utilization Management experience.
• Comfort with learning and adapting to new technologies.

Benefits:

• Employer sponsored health, dental, and vision plan with low or no premium.
• Generous paid time off, $100 monthly mobile or internet stipend, and stock options.
• Parental leave program and 401K program.