Calabria Group- REMOTE Registered Nurse - Clinical Review

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 • * Conduct clinical reviews of medical records and pre-authorization requests to determine medical necessity and appropriateness of care. • * Apply clinical knowledge, judgment, and established guidelines to review complex cases efficiently and accurately. • * Communicate with physicians, healthcare providers, and internal teams to clarify or obtain additional medical documentation. • * Ensure adherence to all federal and state regulations, as well as internal policies related to healthcare reviews and medical necessity. • * Document review findings and decisions in the appropriate system in a clear and concise manner. • * Participate in peer reviews and interdepartmental meetings to support continuous improvement efforts. • * Provide subject matter expertise to support appeals, denials, and audit processes. • * Maintain confidentiality and adhere to HIPAA and company-specific security protocols at all times. • Required Skills and Qualifications • * Active and unrestricted Registered Nurse (RN) license in the United States. • * Proven knowledge of clinical care standards, medical necessity criteria, and utilization management principles. • * Proficient in interpreting clinical notes, treatment plans, and diagnostic reports. • * Exceptional critical thinking, organizational, and decision-making skills. • * Excellent verbal and written communication skills. • * High level of comfort working independently in a remote environment with minimal supervision. • * Strong computer literacy, including proficiency with EMRs, Microsoft Office Suite, and clinical review platforms. • Experience • * Minimum of 3 years of clinical nursing experience, preferably in acute care, case management, or utilization review. • * Prior experience in clinical review, utilization management, or insurance-related roles is highly desirable. • * Experience with healthcare documentation standards, insurance authorizations, and managed care processes. • Working Hours • * Monday to Friday, 8:00 AM – 5:00 PM (your local time zone). • * No weekends or on-call shifts. • * Flexibility may be required depending on workflow or regional review timelines. • Knowledge, Skills, and Abilities • * Strong clinical acumen with the ability to evaluate the appropriateness of care. • * Deep understanding of medical terminology, ICD-10, CPT coding, and evidence-based clinical guidelines. • * Familiarity with NCQA, URAC, and CMS standards. • * Ability to work in a fast-paced, deadline-driven environment. • * Effective time management and multitasking abilities in a virtual setting. • Benefits • * Competitive hourly or salaried compensation (depending on contract). • * 100% Remote – work from anywhere in the U.S. • * Health, dental, and vision insurance (eligibility based on employment type). • * Paid time off and paid holidays (where applicable). • * Ongoing professional development opportunities. • * 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.