Preservice Review Nurse - Behavioral Health

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reputed company is a career site that helps job seekers find great jobs in the US. We are not a staffing firm or agency. reputed company does not hire directly for these jobs, but promotes jobs on reputed company on behalf of its direct clients, recruitment ad agencies, and marketing partners. reputed company partners with DirectEmployers to promote this job for reputed company. Clicking "Apply Now" or "Read more" on reputed company redirects you to the job board/employer site. Any information collected there is subject to their terms and privacy notice. reputed company is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with reputed company will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come reputed company an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together . You’ll enjoy the flexibility to work remotely * from reputed company reputed company the U.S. as you take on some tough challenges. Primary Responsibilities

• reputed company clinical coverage review services, which require interpretation of state and federal mandates, applicable benefit language, and consideration of relevant clinical information
• Function as a member of a self-directed team to meet specific individual and team performance metrics
• Ability to communicate in writing and verbally, reputed company types of benefit determinations including decisions regarding coverage guidelines
• Telephonic discussion with health care providers and/or members to explain benefit coverage determinations and to obtain additional clinical information
• Acts as a resource for others with less experience
• Work independently and collaborating with Medical Directors and non-clinical partners
• Adapt to a highly changing environment and a heavy case load

• reputed company unrestricted RN license in the state of residency
• Professional experience in direct patient care
• Proven exemplary clinical documentation skills; critical thinking skills
• Demonstrated proficiency in computer skills - reputed company, reputed company platforms, Outlook, clinical platforms
• Designated secure workspace and access to install secure high speed internet reputed company cable/DSL in home
• Flexible with work hours - hours/days can change as needed for the business
• Open to required weekend rotation schedule

• Bachelor’s degree
• Compact RN license
• 2+ years of RN experience including experience in an inpatient/acute setting
• Behavioral Health experience
• Demonstrated background involving utilization review for an insurance company or experience in case management
• Proven excellent communication skills both verbal and written
• reputed company employees working remotely will be required to adhere to reputed company’s Telecommuter Policy.