InGenesis is currently seeking a Registered Nurse / RN to work remotely as a Nurse Clinician with our client located in Chattanooga, TN. In this role, you will perform comprehensive reviews of authorization requests, denial interpretation for letters, composing denial letters, retrospective claim review, special review requests, and UM pre-certifications and appeals.

Apply today and we'll reach out to answer any questions you may have!

Job Duties

• Performs thorough research and provide complete documentation for rationale to support determinations.
• Provides specific written instructions regarding additional information necessary to complete the review.
• Performs or participates in special studies or projects/pilots as directed by departmental management.
• Cross functional and accomplished in all ancillary review functions.
• Seek the advice of the Medical Director when medical judgment is required.
• Initiate referrals to accomplish discharge planning when such plans are evident at the time of the request.
• Assist non-clinical staff in performance of administrative reviews.
• Interact with Case Management areas to ensure smooth transfer of member information across the continuum of care.
• Perform other duties as assigned.

Minimum Qualifications

• Current license as a Registered Nurse / RN in Tennessee or compact state.
• 3+ years of varied clinical experience.
• Computer proficiency, including Microsoft Office programs.
• Excellent verbal and written communication skills.
• Must be able to work independently and handle multiple tasks.

Preferred Qualifications

• Bachelor's degree in nursing.
• Proficient knowledge and ability to apply various accreditation requirements (URAC, NCQA, etc.).
• Proficient in interpreting benefits, contract language specifically symptom-driven, treatment driven, look back periods, rider information and medical policy/medical review criteria.

EEO Statement:

InGenesis is proud to be an affirmative action employer and is committed to providing equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity, or Veteran status. If you have a disability or special need that requires accommodation in the hiring process, please let us know by visiting our website at

Company Statement:

InGenesis is one of the largest staffing firms in the industry and is among the largest diversity-owned healthcare staffing firms in North America. InGenesis is dedicated to placing people in positions that preserve life, improve lives, and inspire others. This does not happen without passionate people: skilled colleagues who are motivated to create innovative solutions and deliver superior service to our clients. InGenesis counts almost half of the Fortune 500 in our nearly 300 clients, including clients in the healthcare, life sciences, higher education and pharma industries.