Utilization Review RN
To see similar active jobs please follow this link: Remote Healthcare jobs
Job Description
Are you an experienced Utilization Review RN (Remote) looking for a new opportunity with a prestigious healthcare company? Do you want the chance to advance your career Utilization Review RN (Remote) by joining a rapidly growing company? If you answered 'yes' to any of these questions - Utilization Review RN (Remote) position is for you!
Daily Responsibilities:
Responsible for collaborating with healthcare providers and members to promote quality member outcomes, to optimize member benefits, and to promote effective use of resources.
MAJOR JOB DUTIES AND RESPONSIBILITIES
- Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards, accurately interpreting benefits and managed care products, and steering members to appropriate providers, programs or community resources.
- Applies clinical knowledge to work with facilities and providers for care coordination.
- Works with medical directors in interpreting appropriateness of care and accurate claims payment.
- May also manage appeals for services denied.
- Conducts pre-certification, inpatient, retrospective, out of network and appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.
Requirements:
- Clear and active RN license in state CA
- Can sit anywhere in the US but must have clear/active CA license
- 2 years of acute care clinical experience or Utilization management experience (Surgery Scheduling, Home Health, Medical-Surgical, OB, Surgical)
- Good communication, problem-solving, analytical skills
- Excellent time-management skills
- Must have high speed internet at home
- Good home environment that allows candidates to work from home successfully without interruptions
- Computer Proficient: Able to navigate between multiple open pages/systems; copy/paste
Hours for this Position:
- Monday - Friday 8am-5pm PST
Advantages of this Opportunity:
- Competitive salary, negotiable based on relevant experience
- Benefits offered, Medical, Dental, and Vision
- Fun and positive work environment
Interested in being considered?
If you are interested in applying to this position, please click APPLY now or send your application to:
Christine Morta
Utilization Review RN
To see similar active jobs please follow this link: Remote Healthcare jobs
Job Description
Are you an experienced Utilization Review RN (Remote) looking for a new opportunity with a prestigious healthcare company? Do you want the chance to advance your career Utilization Review RN (Remote) by joining a rapidly growing company? If you answered 'yes' to any of these questions - Utilization Review RN (Remote) position is for you!
Daily Responsibilities:
Responsible for collaborating with healthcare providers and members to promote quality member outcomes, to optimize member benefits, and to promote effective use of resources.
MAJOR JOB DUTIES AND RESPONSIBILITIES
- Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards, accurately interpreting benefits and managed care products, and steering members to appropriate providers, programs or community resources.
- Applies clinical knowledge to work with facilities and providers for care coordination.
- Works with medical directors in interpreting appropriateness of care and accurate claims payment.
- May also manage appeals for services denied.
- Conducts pre-certification, inpatient, retrospective, out of network and appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.
Requirements:
- Clear and active RN license in state CA
- Can sit anywhere in the US but must have clear/active CA license
- 2 years of acute care clinical experience or Utilization management experience (Surgery Scheduling, Home Health, Medical-Surgical, OB, Surgical)
- Good communication, problem-solving, analytical skills
- Excellent time-management skills
- Must have high speed internet at home
- Good home environment that allows candidates to work from home successfully without interruptions
- Computer Proficient: Able to navigate between multiple open pages/systems; copy/paste
Hours for this Position:
- Monday - Friday 8am-5pm PST
Advantages of this Opportunity:
- Competitive salary, negotiable based on relevant experience
- Benefits offered, Medical, Dental, and Vision
- Fun and positive work environment
Interested in being considered?
If you are interested in applying to this position, please click APPLY now or send your application to:
Christine Morta