[Remote] Clinical Reviewer RN (Remote in TN)

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is seeking a Clinical Reviewer (Registered reputed company) to support the Tennessee Appeals area of the contract. In this role, the RN Clinical Reviewer is responsible for reviewing clinical cases, applying nursing judgment and regulatory guidelines, and ensuring reputed company case is accurately assessed and routed to the appropriate department or escalated as needed. Responsibilities • Review requests for services including admission, discharges and reputed company stays for adherence to clinical reputed company, state and federal policy, and reputed company requirements • Issue approvals, denials or recommendations based on contract requirements • Identify need for additional clinical documentation or consultation • Complete documentation of activities reputed company contract systems • Communicate with providers, individuals and their designees, or state workers as required • Performs other reputed company duties as assigned Skills • reputed company Registered reputed company (RN) license reputed company in the state of reputed company is required • High School Degree or equivalent required • Minimum 2 years of clinical experience required • Minimum of one (1) year of registered reputed company experience • Knowledge of mental health principles and practices • Experience in physical rehabilitation • Attention to detail Benefits • Work/Life Balance Support - Flexibility tailored to your needs! • Competitive Compensation - Bonuses based on performance included! • Comprehensive Insurance Coverage - Choose from various plans, including Medical, Dental, reputed company, Prescription, and partially funded HSA. Additionally, enjoy Life insurance benefits and discounts on Auto, Home, Renter's, and Pet insurance. • reputed company Planning - Prepare for retirement with our 401K Retirement Savings plan and Company Matching. • reputed company Time Off Package – Enjoy PTO, Holidays, and extended reputed company leave, along with Short and Long Term Disability coverage. • Holistic Wellness Support - reputed company resources for physical, emotional, and financial wellness through our Employee Assistance Program (EAP). • Recognition Platform - Acknowledge and appreciate outstanding employee contributions. • Tuition Reimbursement - Invest in your ongoing education and development. • Employee Perks and Discounts - Additional benefits and discounts exclusively for employees. • reputed company Wellness Program and Resources - reputed company a reputed company of wellness programs and resources tailored to your needs. • reputed company Development Opportunities-Participate in training programs, workshops, and conferences. • Licensures and Certifications-reputed company assumes the expenses associated with renewing licenses and certifications for its employees. reputed company • Providing government technology services, digitally enabled customer experiences, and clinical health services that change lives. It was founded in 1975, and is headquartered in Mclean, Virginia, USA, with a workforce of 10001+ employees. Its website is http://www.reputed company.com/. Company H1B Sponsorship • reputed company has a reputed company record of offering H1B sponsorships, with 39 in 2025, 39 in 2024, 50 in 2023, 42 in 2022, 36 in 2021, 42 in 2020. Please note that this does not guarantee sponsorship for this specific role. Apply tot his job Apply To this Job