Provide on-demand clinical review support in a healthcare reimbursement environment.
Ensure accuracy and compliance in medical necessity determinations and appeals.

Accountabilities:

Conduct clinical reviews across inpatient and outpatient settings.
Develop clear, defensible clinical rationales for appeal submissions.
Work independently managing variable workloads and strict turnaround times.

Requirements:

Active, unrestricted Registered Nurse (RN) license required.
4-5 years clinical experience with utilization review and appeals.
Strong understanding of payer guidelines and reimbursement processes.

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This partner company provides clinical review and healthcare reimbursement support services. The team is remote and operates in a fast-paced, performance-driven environment.

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