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2h ago Curated

Clinical Review Nurse Lead

Elevance Health

Job description

The Clinical Review Nurse Lead oversees a team of clinical reviewers performing utilization management and prior authorization reviews. Responsibilities include monitoring team performance, ensuring adherence to clinical criteria (e.g., MCG/InterQual), conducting quality audits, and providing training and guidance. This role requires an active RN license, 5+ years of clinical experience, and prior leadership experience. The position is fully remote within the US.

Key responsibilities

  • Supervise a team of clinical review nurses
  • Monitor team performance and adherence to criteria
  • Conduct quality audits and provide feedback
  • Train and mentor team members
  • Handle escalated cases and complex reviews

What you bring

  • Active RN license (compact preferred)
  • 5+ years clinical experience
  • Leadership/supervisory experience
  • Knowledge of MCG/InterQual criteria
  • Strong communication and organizational skills

Tags

RemoteUtilization ReviewLeadershipCompact RN

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