Care Review Clinician (RN) Remote

JOB DESCRIPTION This RN will act as a Care Review Clinician and provide clinical review support for Medicare inpatient utilization management activities. Conducts medical necessity reviews of inpatient admissions and ongoing services using established clinical guidelines, Medicare requirements, and organizational policies. Partners with providers, case management, and care coordination teams to facilitate appropriate care delivery, support member outcomes, and ensure regulatory compliance. Contributes to quality, affordability, and effective resource stewardship through accurate and timely utilization review decisions. This is a telephonic position and productivity is important. Preferred candidates will have previous case management, managed care, or inpatient hospital experience. Experience in a behavioral health setting would be a plus. Schedule: Monday through Friday 7:00AM to 6:00PM EST flexible (No nights, holiday rotation, no call.) Alternative work schedule ava after 18 w...