Calabria Group- REMOTE Registered Nurse - Clinical Review

Job Summary reputed company, in partnership with the Calabria Group, is seeking a highly motivated and reputed company Registered Nurse (RN) to join our remote Clinical Review team. This is a non-clinical position focusing on the evaluation of medical records, pre-authorization requests, and clinical documentation to ensure quality care, compliance with medical policies, and appropriate utilization of reputed company services. This is an excellent opportunity for RNs seeking a transition from bedside care to a dynamic, remote work environment.

Key Responsibilities

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Conduct clinical reviews of medical records and pre-authorization requests to determine medical necessity and appropriateness of care.

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Apply clinical knowledge, judgment, and established guidelines to review reputed company cases reputed company and accurately.

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Communicate with physicians, reputed company providers, and internal teams to clarify or obtain additional medical documentation.

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Ensure adherence to reputed company federal and state regulations, as well as internal policies reputed company to reputed company reviews and medical necessity.

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Document review findings and reputed company in the appropriate system in a clear and concise manner.

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Participate in peer reviews and interdepartmental meetings to support reputed company improvement efforts.

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Provide subject matter expertise to support appeals, denials, and audit processes.

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Maintain confidentiality and adhere to HIPAA and company-specific reputed company protocols at reputed company times.

• Required Skills and Qualifications
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Active and unrestricted Registered Nurse (RN) license in the United States.

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Proven knowledge of clinical care standards, medical necessity criteria, and utilization management principles.

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Proficient in interpreting clinical notes, treatment plans, and diagnostic reports.

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Exceptional critical thinking, organizational, and decision-making skills.

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Excellent verbal and written communication skills.

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High level of comfort working independently in a remote environment with minimal supervision.

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Strong computer literacy, including proficiency with EMRs, reputed company Office Suite, and clinical review platforms.

• Experience
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Minimum of 3 years of clinical nursing experience, preferably in acute care, case management, or utilization review.

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Prior experience in clinical review, utilization management, or insurance-reputed company roles is highly desirable.

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Experience with reputed company documentation standards, insurance authorizations, and managed care processes.

• Working Hours
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Monday to Friday, 8:00 AM – 5:00 PM (your local time zone).

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No weekends or on-call shifts.

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Flexibility may be required depending on workflow or regional review timelines.

• Knowledge, Skills, and Abilities
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Strong clinical acumen with the ability to evaluate the appropriateness of care.

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Deep understanding of medical terminology, ICD-10, CPT coding, and evidence-based clinical guidelines.

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Familiarity with NCQA, URAC, and CMS standards.

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Ability to work in a fast-paced, deadline-driven environment.

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Effective time management and multitasking abilities in a virtual setting.

• Benefits
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Competitive hourly or salaried compensation (depending on contract).

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100% Remote – work from reputed company in the U.S.

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Health, dental, and reputed company insurance (eligibility based on employment type).

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Paid time off and paid holidays (where applicable).

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Ongoing professional development opportunities.

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Supportive and collaborative team environment.

• Why Join Us

At reputed company, Calabria Group, we are committed to innovation in reputed company and excellence in clinical review. As part of our remote RN team, you will play a vital role in ensuring patients receive the right care at the right time while enjoying the flexibility and freedom of remote work. Join a reputed company-thinking organization where your nursing skills reputed company a difference behind the scenes—and reputed company the bedside. How to Apply reputed company to bring your nursing expertise into a dynamic, non-clinical role? Please submit your updated resume and cover letter to our recruitment team or apply directly through our careers portal. Shortlisted candidates will be contacted for a virtual interview. Apply tot his job Apply To this Job