Care Review Clinician (RN) - Reside in PST

JOB DESCRIPTION

_Candidates must reside in the Pacific Standard Time (PST) zone. The standard work schedule is 8:30 AM to 5:00 PM, with a rotating weekend requirement approximately every 7–9 weeks, which may include working a full weekend or a single weekend day._

_Prior authorization experience is required, along with the ability to adapt to changing member needs and a dynamic work environment._

Job Summary

Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care.

Essential Job Duties
• Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/...