RN Clinical Quality Reviewer Job at Virtual Vocations Inc, United States

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  • Virtual Vocations Inc
  • United States

Job Description

Supporting the WISeR Prior Authorization Program, the full-time RN Clinical Quality Reviewer will perform comprehensive clinical reviews, validate documentation accuracy, and assist in physician determination activities, all while working remotely within the US. Key responsibilities Conduct clinical reviews of prior authorization requests in compliance with CMS and internal policies Participate in quality assurance activities to ensure regulatory compliance and identify documentation gaps Collaborate with cross-functional teams to optimize workflows and support operational continuity in a 24/7 environment Required qualifications Active clinical licensure as a Registered Nurse (RN) Experience in reviewing clinical documentation for medical necessity and appropriateness of care Working knowledge of CPT and ICD 10 coding Ability to apply clinical judgment within utilization management or prior authorization workflows Proficiency with healthcare technology platforms and electronic clinical systems

Job Tags

Full time, Remote work

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