CareReview / Solutions / Nurse Review
Clinical Capacity That Scales With Your Volume
Licensed UR nurses providing criteria-based initial review and flexible staffing capacity — so backlogs never become the bottleneck.
Clinical Capacity That Scales With Your Volume
Licensed UR nurses providing criteria-based initial review and flexible staffing capacity — so backlogs never become the bottleneck.
CareReview's Nurse Review solution gives health plans, TPAs, and PBMs flexible, licensed nurse capacity for initial clinical review — screened against InterQual, MCG, NCD/LCD, or client-specific criteria — with escalation to CareReview's physician panel whenever a case doesn't clearly meet criteria. Available for short- or long-term engagements, Nurse Review closes capacity gaps across every line of business we support, without the cost or delay of building an internal bench.
Core Nurse Review Services
Initial Clinical Review
Nurse-led screening against InterQual, MCG, NCD/LCD, or client-specific criteria, with escalation to physician review when medical necessity isn't clearly established.
ER Overutilization Review
Nurse review of emergency visits against the prudent layperson standard, flagged for physician review when criteria isn't met.
DME Initial Review
Criteria-based nurse screening of durable medical equipment requests, confirming medical necessity before physician escalation.
Level of Care Review
Nurse assessment confirming the appropriate setting — inpatient, observation, skilled care, LTACH, or ICU/NICU — for each case.
Clinical Incident Management
Nurse-led investigation and remediation support for clinical incidents, fully documented for audit and compliance review.
Flexible Staffing & Backlog Support
Short- or long-term nurse capacity that scales with volume, clears backlogs, and provides business continuity coverage.
Why CareReview for Nurse Review
- Nationwide bench of licensed UR nurses, credentialed and state-licensed everywhere licensure is required.
- Clear escalation pathway to CareReview's specialty-matched physician panel whenever a case falls outside nurse-level criteria.
- URAC-accredited IRO and HITRUST certified — the same accreditation backbone behind every CareReview solution.
- Stradix® platform for real-time case submission, tracking, and reporting, or work directly inside your existing system.