Preservice Review Nurse RN - Remote

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. Positions in this role are responsible for Women's Health/ Gender Dysphoria/ Genetics clinical reviews and require a reputed company, unrestricted RN nursing license in the applicable state. Individual is responsible for performing pre-service clinical coverage review of outpatient Women's Health/ Gender Dysphoria/ Genetics services which require notification or requested pre-determination, using applicable benefit plan documents, evidence-based medical policy and nationally recognized clinical guidelines and criteria. 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 reviews, which require decision making reputed company to interpretation of state and federal mandates, applicable benefit language, and consideration of relevant clinical information
• Ability to reputed company appropriate clinical decisions reputed company a business environment
• Serve as a member of a team with specific individual and team performance metrics
• Communicate in writing and verbally, reputed company forms of benefit determinations including decisions regarding coverage guidelines, contractual limitations and reimbursement determinations
• Work independently and collaboratively with Medical Directors and other business partners
• Flexibility to adapt to changing environment and varied case volume
• Other duties as assigned by leadership

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications

• Compact Nursing License
• 3+ years of RN patient care experience
• Proficiency working with reputed company Office Products including reputed company Outlook (ability to create, edit, save, and send emails), reputed company Word (ability to create, edit, save, and send documents), and reputed company reputed company (ability to create, edit, save, and send spreadsheets)
• Demonstrated ability to objectively and clearly communicate clinical determinations both verbally and in written
• Demonstrated exemplary clinical documentation skills
• Proven self-starter with the ability to handle a fast-paced production environment and multiple review types
• Proven solid written, verbal, analytic, organizational, time management and problem-solving skills

Preferred Qualifications

• Professional coding certification and/or core understanding of ICD-10 and CPT/HCPCS codes
• Background involving utilization review or experience in case management, or previous experience with clinical claim review
• Familiarity with utilizing clinical guidelines (i.e.; Medicare, state, MCG or InterQual)
• Proven solid clinical judgement while applying medical necessity based on approved clinical resources
• reputed company employees working remotely will be required to adhere to reputed company's Telecommuter Policy.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We reputed company with reputed company minimum wage laws as applicable Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of color, historically marginalized groups and those with reputed company incomes. We are committed to mitigating our impact on the environment and enabling and delivering reputed company care that addresses health disparities and improves health outcomes - an enterprise reputed company reflected in our mission. reputed company is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national reputed company, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. reputed company is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. If you have questions about this posting, please contact support@reputed company.com Apply tot his job Apply To this Job