MUST READ!! Job Description: Conduct reviews of medical records, treatment plans, and patient information to determine the medical necessity and appropriateness of healthcare services, including hospital admissions, continued stays, and outpatient services. Collaborate with physicians, other healthcare professionals, and insurance providers to develop and implement care plans that meet patient needs and ensure cost-effective care. Assess patient conditions, treatment progress, and response to therapies to make informed decisions regarding the continuation, modification, or discontinuation of healthcare services. Maintain accurate and detailed records of utilization reviews, care plans, and communication with healthcare providers and payers. Advocate for patients' rights and needs, ensuring they receive appropriate care while managing costs effectively. Requirements: At least 2 years of hospital experience Active PRC License Strong clinical knowledge Must provide own review and working equipment Stable internet connection at home Benefits: Work from home 100% NCLEX Sponsorship to qualified candidates Performance Incentives Paid Leaves HMO and Life Insurance