Nurse Reviewer

Gainwell is seeking a Nurse Reviewer to perform clinical reviews and determine if medical record documentation supports the need for services based on clinical criteria and utilization guidelines. The role involves assembling appeal packages for independent medical reviews, ensuring the clinical appropriateness of determination letters, and performing triage and necessity reviews for expedited appeal requests. This position requires applying critical thinking to maintain production goals and quality standards while assisting management with training and mentoring new reviewers.