Clinical Review Nurse (RN) – Hybrid

What We're Looking For

Required Qualifications

• Active Pennsylvania Registered Nurse (RN) license.
• Strong clinical nursing experience.
• Excellent assessment and critical-thinking skills.
• Strong written and verbal communication abilities.
• Ability to work independently and manage multiple priorities.
• Proficiency with Microsoft Office, including Outlook, Word, and Excel.
• Strong computer skills and ability to learn new software systems quickly.
• Ability to review and interpret medical records and clinical documentation.
   

Preferred Experience

Experience in any of the following areas is highly valued:

• Case Management
• Home Health
• Long-Term Care
• Skilled Nursing
• Rehabilitation Nursing
• Managed Care
• Utilization Review
• Quality Assurance
• Behavioral Health
• Hospice or Palliative Care
• Adult or Geriatric Care
• Community-Based Services

What You'll Do

• Review clinical documentation, assessments, service plans, and incident reports.
• Evaluate information to ensure participant health, safety, and well-being.
• Analyze medical records and supporting documentation.
• Identify trends, concerns, and opportunities for quality improvement.
• Collaborate with social workers, providers, care managers, and other healthcare professionals.
• Prepare written summaries, findings, and recommendations.
• Provide guidance and technical assistance regarding policies and procedures.
• Participate in quality assurance and compliance activities.
• Attend meetings and contribute to process improvement initiatives.
• Utilize multiple electronic systems and databases to document and track case activity.