Registered Nurse/Medicaid Clinical Reviewer - Remote

Overview

This position is for a Registered Nurse serving as a Medicaid Clinical Reviewer, conducting clinical reviews for Medicaid cases in a fully remote capacity.

In Short

• Fully remote position
• Full-time employment
• Hourly rate of $50
• Conduct clinical reviews for Medicaid cases
• Ensure compliance with state regulations
• Participate in quality improvement initiatives
• Work Monday to Friday, 9:00 AM - 5:30 PM
• Collaborate with administrative staff for training and problem-solving
• Review medical records using InterQual criteria
• Validate itemized bills and write responses to hospitals

Requirements

• Experience as a Registered Nurse
• Knowledge of Medicaid regulations
• Ability to conduct utilization reviews
• Familiarity with InterQual criteria
• Strong communication skills
• Detail-oriented with strong analytical skills
• Ability to work independently and as part of a team
• Commitment to quality improvement
• Proficient in electronic documentation and record-keeping
• Ability to manage multiple tasks effectively

Benefits

• Professional growth opportunities
• Supportive work environment
• Impactful work contributing to patient outcomes
• Flexible work schedule
• Collaborative training specific to clinical objectives