Nurse – Clinical Review

Job overview

The Nurse – Clinical Review role is fully remote within the United States. The base salary is $65,000 annually for an LVN/LPN or $75,000 annually for an RN; performance-based bonuses, incentive pay, or commissions may also be available. HealthHelp supports specialty clinical review programs, including imaging, cardiology, musculoskeletal care, sleep, oncology, and genetic testing. The nurse reviews prior authorization requests against evidence-based clinical guidelines and applicable policies, approving requests that meet criteria and referring others to physician reviewers. The role helps ensure timely, accurate utilization review while meeting productivity, quality, documentation, and regulatory standards.

What you'll do

• Review prior authorization requests for medical necessity
• identify criteria met or unmet and missing documentation
• approve qualifying requests and refer others to physician reviewers with clinical summaries
• meet productivity, quality, and turnaround standards
• document reviews
• contact providers, staff, and members for information
• handle escalated and expedited cases
• participate in quality audits and calibration.

What we're looking for

Skills & competencies

nurse

clinical review

remote us

healthhelp

prior authorization

utilization review

medical necessity

rn or lpn/lvn license

two years review experience

specialty programs

$65,000 lvn/lpn

$75,000 rn

remote work

Work arrangement

• Weekend coverage required

Benefits & perks

• Base salary of $65,000 for LVN/LPN or $75,000 for RN
• role may also be eligible for performance-based bonuses, incentive pay, or commissions.

Why this role

Fully remote U.S. role; structured six-week training Monday–Friday, 8:00 a.m.–4:30 p.m. CST; regular schedule after training 10:30 a.m.–7:00 p.m. CST; supported production ramp and QA coaching.

About the employer

HealthHelp - A WNS Company is hiring for this role. Industry: Offices of All Other Miscellaneous Health Practitioners. Sector: 62.