Care Review Clinician (RN) - reside in PST or MST

JOB DESCRIPTION Candidates must reside in the PST or MST time zones and hold an active RN Compact License. This is a fully remote position requiring availability on Saturdays and Sundays, plus two additional weekdays, with flexibility to accommodate changing business needs. The schedule consists of four 10-hour shifts per week. The ideal candidate will have a strong clinical background in ICU and/or Emergency Room nursing. Prior Utilization Management (UM) experience is preferred. Success in this role requires adaptability, strong critical thinking skills, and the ability to pivot quickly in a fast-paced environment where priorities and processes frequently evolve. 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...