1 week ago Be among the first 25 applicants Job Title:Clinical Review Nurse (RN) – Utilization Management Location:Oregon or bordering states Duration:3+ Months Job Summary: This role uses clinical expertise to review medical records for medical appropriateness based on established criteria and contractual guidelines. The nurse will ensure timely, accurate case handling and serve as a key liaison between providers and internal departments. Key Responsibilities: Conduct medical record reviews in accordance with clinical and contractual standards Prioritize and manage daily case queues to meet workload demands Collaborate with supervisors on quality assurance and continuous improvement Maintain up-to-date knowledge of review processes and clinical best practices Serve as a liaison for provider communications and issue resolution Build and maintain positive relationships with internal and external stakeholders Participate in required training and meetings for updates and compliance Crosstrain to support broader team needs and ensure workforce flexibility Comply with HIPAA and all corporate privacy and security policies Required Qualifications: Willingness or ability to be licensed in Nebraska if not compact-eligible Bachelor’s degree in a healthcare-related field At least 2 years of experience in Utilization Management or Clinical Review Preferred Qualifications: ·Experience in Case Management ·Strong understanding of medical terminology, records, and disease processes ·Solid clinical assessment and critical thinking abilities · Excellent written and verbal communication skills Seniority level Seniority level Entry level Employment type Employment type Contract Job function Job function Health Care Provider Industries Professional Services Referrals increase your chances of interviewing at Metasys Technologies by 2x Sign in to set job alerts for “Registered Nurse” roles. Care Management Nurse (Future Opportunities) Oregon, United States $34.20-$55.70 5 days ago Care Management Nurse (Future Opportunities) Care Management Nurse (Future Opportunities) Care Management Nurse (Future Opportunities) Care Management Nurse (Future Opportunities) Clinical Program Coordinator RN *Remote* Clinical Program Coordinator RN *Remote* Medford, OR $2,266.84-$2,266.84 2 weeks ago Care Management Nurse (Future Opportunities) RN Clinical Document Integrity Specialist Oregon, United States $150,000.00-$300,000.00 5 days ago We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI. #J-18808-Ljbffr
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