What are the responsibilities and job description for the Registered Nurse position at ChaseSource?
Job Title: Service Delivery – Clinical Data Services Representative
Pay Rate: $40.74 per hour
Employment Type: Full-Time, Remote
Join Our Team!
We are excited to offer a fully remote opportunity for a dedicated and detail-oriented Registered Nurse (RN) to join our Health & Public Service (H&PS) team as a Clinical Data Services Representative. If you’re looking for a role that allows you to apply your clinical expertise without direct patient care—and you enjoy reviewing clinical information to support quality outcomes—this may be the perfect fit.
In this role, you will support pre-service, concurrent, and retrospective reviews to ensure medically appropriate, cost-effective care for members while contributing to process improvements that make a real impact.
Schedule:
Shifts fall between 7:00 AM – 7:00 PM, with a standard schedule of 10:00 AM – 7:00 PM. Occasional overtime may be required and must be approved in advance.
Key Responsibilities
- Perform pre-service, concurrent, and retrospective reviews for outpatient and out-of-network services
- Assess medical necessity and treatment appropriateness within your professional nursing scope
- Collaborate with healthcare providers to support member outcomes and maximize benefits
- Ensure all reviews comply with Medicaid standards and Texas Administrative Code (TAC) requirements
- Interpret and apply medical necessity criteria
- Maintain accurate, timely documentation following internal review processes
- Participate in team meetings and contribute to ongoing process improvement initiatives
Required Knowledge, Skills & Abilities
- Active Registered Nurse (RN) license
- Strong understanding of Texas Administrative Code (TAC) and Medicaid guidelines
- Ability to independently assess medical necessity and treatment settings
- Excellent communication skills with healthcare providers
- Strong organizational, analytical, and critical-thinking skills
- Proficiency with Microsoft Word and Excel preferred
- Prior experience in clinical review, utilization management, or similar roles is a plus
Ready to take the next step in your clinical career—from the comfort of home? Apply today and join a team committed to quality, compliance, and exceptional service delivery.
#ACCLSB
By applying for this position, you consent to receive calls, AI-generated calls, text messages, and emails from ChaseSource, its affiliates, and contracted partners regarding job opportunities and related updates. Message frequency may vary. Standard message and data rates may apply. Carriers are not responsible for delayed or undelivered messages. You can opt out at any time by replying STOP or get assistance by replying HELP. For more information, please review our privacy policy at https://chasesource.com/privacy-policy/.
ChaseSource is an Equal Opportunity Employer. All applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status, genetic information, pregnancy, or any other legally protected status.