Job Description
Job Summary
- Progressive Technology, in partnership with the Calabria Group, is seeking a highly motivated and experienced Registered Nurse (RN) to join our remote Clinical Review team. This is a non-clinical position focusing on the evaluation of medical records, pre-authorization requests, and clinical documentation to ensure quality care, compliance with medical policies, and appropriate utilization of healthcare services. This is an excellent opportunity for RNs seeking a transition from bedside care to a dynamic, remote work environment.Key Responsibilities
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- Conduct clinical reviews of medical records and pre-authorization requests to determine medical necessity and appropriateness of care.
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- Apply clinical knowledge, judgment, and established guidelines to review complex cases efficiently and accurately.
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- Communicate with physicians, healthcare providers, and internal teams to clarify or obtain additional medical documentation.
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- Ensure adherence to all federal and state regulations, as well as internal policies related to healthcare reviews and medical necessity.
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- Document review findings and decisions in the appropriate system in a clear and concise manner.
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- Participate in peer reviews and interdepartmental meetings to support continuous improvement efforts.
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- Provide subject matter expertise to support appeals, denials, and audit processes.
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- Maintain confidentiality and adhere to HIPAA and company-specific security protocols at all times.
- Required Skills and Qualifications
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- Active and unrestricted Registered Nurse (RN) license in the United States.
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- Proven knowledge of clinical care standards, medical necessity criteria, and utilization management principles.
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- Proficient in interpreting clinical notes, treatment plans, and diagnostic reports.
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- Exceptional critical thinking, organizational, and decision-making skills.
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- Excellent verbal and written communication skills.
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- High level of comfort working independently in a remote environment with minimal supervision.
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- Strong computer literacy, including proficiency with EMRs, Microsoft Office Suite, and clinical review platforms.
- Experience
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- Minimum of 3 years of clinical nursing experience, preferably in acute care, case management, or utilization review.
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- Prior experience in clinical review, utilization management, or insurance-related roles is highly desirable.
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- Experience with healthcare documentation standards, insurance authorizations, and managed care processes.
- Working Hours
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- Monday to Friday, 8:00 AM – 5:00 PM (your local time zone).
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- No weekends or on-call shifts.
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- Flexibility may be required depending on workflow or regional review timelines.
- Knowledge, Skills, and Abilities
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- Strong clinical acumen with the ability to evaluate the appropriateness of care.
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- Deep understanding of medical terminology, ICD-10, CPT coding, and evidence-based clinical guidelines.
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- Familiarity with NCQA, URAC, and CMS standards.
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- Ability to work in a fast-paced, deadline-driven environment.
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- Effective time management and multitasking abilities in a virtual setting.
- Benefits
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- Competitive hourly or salaried compensation (depending on contract).
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- 100% Remote – work from anywhere in the U.S.
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- Health, dental, and vision insurance (eligibility based on employment type).
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- Paid time off and paid holidays (where applicable).
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- Ongoing professional development opportunities.
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- Supportive and collaborative team environment.
- Why Join Us
At Progressive Technology, Calabria Group, we are committed to innovation in healthcare and excellence in clinical review. As part of our remote RN team, you will play a vital role in ensuring patients receive the right care at the right time while enjoying the flexibility and freedom of remote work. Join a forward-thinking organization where your nursing skills make a difference behind the scenes—and beyond the bedside.
How to Apply
Ready to bring your nursing expertise into a dynamic, non-clinical role?
Please submit your updated resume and cover letter to our recruitment team or apply directly through our careers portal. Shortlisted candidates will be contacted for a virtual interview.
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