Clinical Review Intake Nurse

The Clinical Review Intake Nurse" is a registered nurse or LPN who primarily functions as the initial point of contact for incoming patient cases, reviewing medical records and patient information to assess the clinical necessity of requested services, often within the context of insurance authorization, ensuring compliance with established guidelines and standards of care, and coordinating further evaluation or treatment with appropriate healthcare providers.


Key responsibilities of a clinical review intake nurse:

Patient intake and data collection:

Reviewing patient medical records, including diagnoses, medications, lab results, and imaging studies, to gather necessary clinical information.


Medical necessity assessment:

Evaluating whether requested services, like procedures, medications, or hospital admissions, are clinically necessary based on established criteria and insurance policies.


Clinical review and authorization:

Determining if a patient's request meets the medical necessity standards for authorization and communicating decisions to providers and patients.


Prior authorization process:

Managing the process of obtaining prior authorization for necessary services from insurance companies.


Communication with providers:

Contacting referring physicians or other healthcare providers to clarify clinical details or request additional information for accurate assessment.


Case management:

Assigning cases to appropriate clinical reviewers based on complexity or specialty needs.


Documentation and reporting:

Maintaining detailed records of patient interactions, clinical reviews, and authorization decisions in electronic health records.


Quality assurance:

Adhering to established clinical guidelines and quality standards for patient care and review processes.


Skills and qualifications for a clinical review intake nurse:

Registered Nurse (RN) or Licensed Practical Nurse (LPN) license:

Must be a licensed registered nurse with current clinical practice experience.


Strong clinical knowledge:

Comprehensive understanding of medical conditions, diagnoses, treatment options, and standard of care practices.


Analytical skills:

Ability to critically evaluate medical information and make informed decisions based on established criteria.


Excellent communication skills:

Clear and concise communication with patients, providers, and insurance companies.


Attention to detail:

Accurate data entry and thorough review of medical records.


Computer proficiency:

Familiarity with electronic medical records (EMR) systems and utilization management software.

Benefits:
• Health, Dental, Vision
• Life Insurance
• Travel Stipend
• 401k + Company match
• Paid holidays.
• PTO package
• Paid orientation
• Employee Referral Program

Salary: Rates differ for LPN and RNs and is based on experience.
LPN: $65K+
RN: $94K +