RN Clinical Reviewer

Metasys Technologies; Duluth (GA); On-site; USD 70,000 - 110,000; Full time

Job summary

A leading company is seeking a Clinical Review Nurse (RN) for Utilization Management. In this role, you will leverage clinical expertise to ensure medical appropriateness in record reviews and act as a liaison between providers. The ideal candidate will have a Bachelor's degree in a healthcare field and at least 2 years of relevant experience, ensuring timely and accurate case handling.

Qualifications

• 2+ years of experience in Utilization Management or Clinical Review required.
• Willingness to be licensed in Nebraska if not compact-eligible.
• Strong understanding of medical terminology and records.

Responsibilities

• Conduct medical record reviews in accordance with standards.
• Prioritize and manage daily case queues.
• Collaborate on quality assurance and improvements.

Skills

Clinical assessment

Critical thinking

Written communication

Verbal communication

Education

Bachelor’s degree in a healthcare-related field

Job description

1 week ago Be among the first 25 applicants

Job Title:Clinical Review Nurse (RN) – Utilization Management

Location:Oregon or bordering states

Duration:3+ Months

Job Summary:

This role uses clinical expertise to review medical records for medical appropriateness based on established criteria and contractual guidelines. The nurse will ensure timely, accurate case handling and serve as a key liaison between providers and internal departments.

Key Responsibilities:

• Conduct medical record reviews in accordance with clinical and contractual standards
• Prioritize and manage daily case queues to meet workload demands
• Collaborate with supervisors on quality assurance and continuous improvement
• Maintain up-to-date knowledge of review processes and clinical best practices
• Serve as a liaison for provider communications and issue resolution
• Build and maintain positive relationships with internal and external stakeholders
• Participate in required training and meetings for updates and compliance
• Crosstrain to support broader team needs and ensure workforce flexibility
• Comply with HIPAA and all corporate privacy and security policies

Required Qualifications:

• Willingness or ability to be licensed in Nebraska if not compact-eligible
• Bachelor’s degree in a healthcare-related field
• At least 2 years of experience in Utilization Management or Clinical Review

Preferred Qualifications:

·Experience in Case Management

·Strong understanding of medical terminology, records, and disease processes

·Solid clinical assessment and critical thinking abilities

· Excellent written and verbal communication skills

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Contract

Job function

• Job function

  Health Care Provider

• Industries

  Professional Services

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