Care Review Clinician (RN) Remote

JOB DESCRIPTION This RN will act as a Care Review Clinician supporting our Medicare members. The position is fully remote. Excellent computer skills and attention to detail are very important to multitask between systems, talk with providers on the phone, and adhere to Medicare guidelines. This is a remote position and productivity is important. Preferred candidates will have previous utilization management, managed care, or post-acute experience. Schedule: Monday through Friday 8:30AM to 5:00PM EST (Occasional weekends, no nights, occasional holidays.) Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. Essenti...