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2h ago Curated

Nurse Reviewer I

Elevance Health

Job description

The Nurse Reviewer I is responsible for pre-service, concurrent, and retrospective review of inpatient and outpatient services to determine medical necessity and appropriateness of care using clinical guidelines. This is a remote role requiring an active, unrestricted RN license in the state of residence (compact preferred) and at least 2 years of clinical nursing experience. The role involves reviewing clinical documentation, applying criteria, and making coverage determinations. No in-person patient care is involved.

Key responsibilities

  • Conduct pre-service, concurrent, and retrospective reviews
  • Determine medical necessity using clinical guidelines
  • Review clinical documentation and apply criteria
  • Make coverage determinations and document decisions

What you bring

  • Active RN license (compact preferred)
  • 2+ years clinical nursing experience
  • Knowledge of utilization review criteria
  • Strong clinical judgment

Tags

RemoteUtilization ReviewCompact RN

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