State Licensed RN Reviewer
Company: VirtualVocations
Location: Vista
Posted on: May 20, 2025
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Job Description:
A company is looking for an RN Reviewer.
Key Responsibilities
Perform medical necessity reviews including inpatient, concurrent,
prior authorization, and retrospective reviews
Consult with Medical Directors on cases that do not meet applicable
criteria or medical policies
Document clinical information accurately and maintain compliance
with accreditation and regulatory requirements
Required Qualifications
Registered Nurse with an active, unencumbered license in the state
of residence
Minimum of 3 years of clinical experience, with required
Utilization Management experience
Experience in acute care and/or post-acute care environments
Preferred Bachelor's degree in Nursing, Business, or equivalent
professional work experience
Proficient user of MCG guidelines and familiarity with NCQA and CMS
standards
Keywords: VirtualVocations, Monterey Park , State Licensed RN Reviewer, Healthcare , Vista, California
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