Clinical Review Manager
Tennessee, United States of America
Full Time
4 weeks ago
Visa Sponsor
Key skills
Remote Work
About this role
Role Overview
- Conduct comprehensive clinical reviews of medical service requests
- Support utilization management activities such as pre-certifications, appeals, and retrospective reviews
- Collaborate with the Medical Director on escalated cases
Requirements
- Registered Nurse (RN) with active license in Tennessee
- 3 years clinical experience required
- Proficient in Microsoft Office
- Working knowledge of URAC, NCQA, and CMS accreditations
- Ability to manage multiple projects and priorities
Benefits
- Remote work options
- Flexible schedule
- Professional development opportunities
- 401(k) matching
- Health insurance