Physical Health Registered Nurse (Remote)

Responsibilities: The Physical Health Registered Nurse performs clinical reviews to determine the medical necessity and appropriateness of service authorization requests. They coordinate with providers and internal teams to facilitate utilization management processes and ensure safe enrollee discharges.

Requirements: Requires an Associate Degree in Nursing (BSN preferred) and an active RN license in North Carolina or a Compact license. Candidates must have five years of clinical experience, including at least two years in acute care and experience in managed care utilization management.

Key skills: Clinical Review, Medical Necessity Determination, Utilization Management, Discharge Planning, Case Management, Microsoft Office, Problem Solving, Critical Thinking, Conflict Resolution, Electronic Communication, Patient Coordination, Regulatory Compliance

Keywords: Registered Nurse, Utilization Management, Medical Necessity, Managed Care, Acute Care, RN License, Nurse Licensure Compact, Clinical Review, Discharge Planning, MCIS, Inter-rater Reliability, Healthcare System, Behavioral Health, NCDHHS, Care Management Platform