RN Clinical Reviewer

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

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