Care Review Clinician (RN) - Remote in FL (Hiring Immediately)

About this role

JOB DESCRIPTION Must reside in Florida 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 servic…