Nurse Reviewer 1

The Nurse Reviewer 1 conducts preauthorization, out-of-network, and appropriateness of treatment reviews for diagnostic imaging services using clinical guidelines. Collaborates with healthcare providers and members to promote appropriate, high-quality, and effective use of diagnostic imaging. Conducts initial medical necessity clinical screening, reviews exception preauthorization requests, notifies providers of determinations, and follows up for additional clinical information. Requires ASN and 3 years clinical nursing experience in ambulatory or hospital setting, or 1 year in utilization/medical/quality management or call center. Current unrestricted RN license in applicable state(s) required. Familiarity with UM guidelines, ICD-10, and managed care preferred. Work schedule: Monday-Friday with weekend rotation every 14 weeks. Training: Monday-Friday 8am-4:30pm CST for at least 3 weeks. Virtual role with required in-person training sessions.