Care Review Clinician (RN) Remote (Must Work PST)

JOB DESCRIPTION This RN will support Utilization Review for our NV Medicaid members. Excellent computer skills and attention to detail are very important to multitask between systems, talk with providers on the phone, and enter accurate contact notes. This is a telephonic position and productivity is important. Preferred candidates will have previous utilization management, managed care, or inpatient hospital experience. Experience in a behavioral health setting would be a plus. Schedule: Monday through Friday 8:00AM to 5:00PM PST (Weekends and holidays as needed). 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 ca...