Post-Service Clinical Nurse

Medasource is a leading consulting and professional services firm supporting organizations across the healthcare ecosystem – including Life Sciences, RCM/Payers, Technology, Government and Nursing & Allied Health. Recognized for our commitment to our employees, consultants, and the communities we serve, we deliver solutions that drive meaningful progress across healthcare. With a nationwide footprint of 33 offices and 1,900+ active consultant placements across 120+ clients who are actively engaging Medasource talent, we continue to expand our impact as we advance the future of healthcare, one client at a time.

Title: Post-Service Clinical Review Nurse (RN) Location: Remote – Must Reside in California Type: Full-Time Contract We are seeking an experienced Clinical Review Nurse (RN) to support a high-impact retrospective claims review program. This role is responsible for evaluating medical claims and records to ensure services align with clinical guidelines, medical necessity, and reimbursement policies. This position is ideal for nurses with experience in post-service review, utilization management, or prior authorization, who are comfortable working in a fast-paced, production-driven environment.

Perform retrospective clinical claim reviews and make initial determinations using evidence-based guidelines Evaluate claims for medical necessity, coding accuracy, and policy compliance Review outpatient services including DME, radiology, labs, and genetic testing Prepare cases for Medical Director review when needed and communicate determinations Ensure documentation meets regulatory and accreditation standards Prioritize workload to meet strict turnaround times Identify quality of care concerns and escalate appropriately Collaborate with claims, appeals, and care management teams