What are the responsibilities and job description for the Registered Nurse position at ChaseSource?
Job Title: Service Delivery – Clinical Data Services Representative
Employment Type: Remote, Full-Time
Description
We are seeking a Clinical Data Services Representative to join our Health & Public Service (H&PS) team at Level 10. This role is designed for a Registered Nurse (RN) who will conduct pre-service, concurrent, and retrospective reviews to support quality member outcomes and ensure medically appropriate, cost-effective care. The position does not involve direct patient care and requires availability for shifts between 7:00 AM and 7:00 PM, with a standard schedule of 10:00 AM to 7:00 PM. Overtime may be required and must be approved.
Responsibilities
- Conduct pre-service, concurrent, and retrospective reviews of outpatient and out-of-network services
- Assess medical necessity and appropriateness of treatment settings within professional scope
- Collaborate with healthcare providers to promote quality outcomes and optimize member benefits
- Promote effective use of healthcare resources while ensuring compliance with Medicaid standards
- Apply relevant rules from the Texas Administrative Code (TAC)
- Review and interpret medical necessity requirements
- Maintain accurate documentation and follow internal review procedures
- Participate in team meetings and contribute to process improvement initiatives
Knowledge, Skills & Abilities
- Strong understanding of Texas Administrative Code and Medicaid guidelines
- Ability to assess medical necessity and treatment appropriateness
- Effective collaboration and communication with healthcare providers
- Proficiency in Microsoft Word and Excel preferred
- Strong organizational and analytical skills
- Ability to work independently and manage time effectively
- Experience in clinical review or utilization management roles preferred
Requirements
- Registered Nurse (RN) license in good standing
- Availability to work 8-hour shifts between 7:00 AM and 7:00 PM, with a standard shift of 10:00 AM to 7:00 PM
- No visa restrictions
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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.