RN Clinical Reviewer

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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
  
  Entry level

• Employment type
  
  Contract

• Job function
  
  Health Care Provider
• Industries Professional Services

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