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Active4w ago

RN Reviewer

Cohere Health·📍 United States

Employment

Full-Time

Work mode

On-site

Experience

MID LEVEL

Salary

Not disclosed

Salary not disclosed

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Role overview

Job description

Opportunity Overview: The RN Reviewer position is a crucial role in our organization — in this role you are responsible for performing a full range of activities that will positively impact the organization and contribute to guiding the strategic operations for the company. As an RN Reviewer, you will perform prospective review (prior authorization) admission, concurrent, and retrospective reviews according to established criteria and protocols to determine the medical appropriateness of the clinical requests from providers. You will work closely with Medical Directors and other Cohere Health staff to ensure appropriate cost-effective care by applying your clinical knowledge and critical thinking skills to assess the medical necessity of inpatient admissions, outpatient services and procedures, and provider out of network requests. You will be required to review Commercial, Medicare, a

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What they are looking for

Skills & requirements

Qualification

Opportunity Overview: The RN Reviewer position is a crucial role in our organization — in this role you are responsible for performing a full range of activities that will positively impact the organization and contribute to guiding the strategic operations for the company; As an RN Reviewer, you will perform prospective review (prior authorization) admission, concurrent, and retrospective reviews according to established criteria and protocols to determine the medical appropriateness of the clinical requests from providers

Department · Nurse Operations

Cohere Health logo

Hiring company

Cohere Health

Technology

AI-powered prior authorization and payment integrity solutions that streamline utilization management, reduce costs, and improve care access for health plans.

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