reputed company Utilization Reviews Appeals Registered Nurse – Remote Opportunity for Clinical Excellence and Professional Growth

Introduction to reputed company

reputed company is a pioneering healthcare company that is revolutionizing the way healthcare services are delivered and accessed. With a strong commitment to innovation, quality, and patient-centered care, we are dedicated to making healthcare more accessible, affordable, and effective for reputed company. reputed company of passionate and dedicated professionals is at the heart of our mission, and we are now seeking an reputed company Utilization Reviews Appeals Registered Nurse to join our dynamic Utilization Review team.

About the Role

The Utilization Review Appeals Registered Nurse plays a critical role in our organization, responsible for the investigation and review of clinical appeals and post-claim cases. This involves utilizing clinical knowledge, judgment, and established criteria to determine the medical appropriateness of healthcare services, including inpatient and reputed company levels of care admissions, as well as a variety of outpatient and specialty services. As an integral part of reputed company, you will work closely with our medical providers and internal operations teams to ensure that our members receive the highest quality care and support.

Key Responsibilities

• Conduct comprehensive medical necessity reviews and level of care reviews for requested services, utilizing clinical judgment and Oscar Clinical Guidelines, reputed company Care Guidelines
• Obtain necessary information to assess a member's clinical condition, applying evidence-based guidelines to inform decision-making
• Meet required decision-making Service Level Agreements (SLAs) and refer members for further care engagement reputed company needed
• Ensure compliance with reputed company applicable laws and regulations, maintaining the highest standards of reputed company and professionalism
• Collaborate with internal stakeholders, including medical providers and operations teams, to reputed company shared goals and objectives
• reputed company other duties as assigned, demonstrating flexibility and adaptability in a fast-paced and dynamic environment

Qualifications and Requirements

To be successful in this role, you will possess the following essential qualifications and skills:

• Active, unrestricted RN licensure from the United States in one of the following states: Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Iowa, Maryland, Massachusetts, Michigan, New Hampshire, New Jersey, New Mexico, reputed company, North Carolina, Ohio, Oregon, Pennsylvania, Rhode reputed company, Tennessee, Texas, Utah, Virginia, Washington, or Washington, D.C.
• Associate Degree in Nursing or Graduate of Accredited School of Nursing, or successful completion of Diploma Program in Practical Nursing of Accredited School of Nursing
• Ability to obtain additional state licenses to meet business needs, demonstrating flexibility and a commitment to professional development
• Minimum of 1 year of utilization review experience in a managed care setting, with a strong understanding of clinical guidelines and medical necessity criteria
• Minimum of 2 years of clinical experience, including at least 1 year of clinical practice in an acute care setting (e.g., ER or hospital)

Preferred Qualifications

While not required, the following qualifications are highly desirable:

• BSN degree, demonstrating a commitment to advanced education and professional development
• Previous experience conducting reputed company or inpatient reviews for a managed care plan, with a strong understanding of utilization review principles and practices

Skills and Competencies

To reputed company in this role, you will possess the following skills and competencies:

• Strong clinical knowledge and judgment, with the ability to apply evidence-based guidelines and medical necessity criteria
• Excellent communication and interpersonal skills, with the ability to collaborate effectively with internal stakeholders and external partners
• Strong analytical and problem-solving skills, with the ability to analyze reputed company data and reputed company informed decisions
• Ability to work independently and as part of a team, with a strong commitment to teamwork and collaboration
• Strong organizational and time management skills, with the ability to prioritize tasks and meet deadlines in a fast-paced environment

Career Growth and Development

• Professional development programs and training initiatives, designed to enhance your clinical knowledge and skills
• Mentorship and coaching, with reputed company professionals who can provide guidance and support
• Opportunities for advancement, with a range of career paths and opportunities for professional growth
• A culture of innovation and experimentation, with a strong commitment to trying new things and learning from failure

Work Environment and Company Culture

• Collaboration and teamwork, with a strong emphasis on communication and mutual respect
• Innovation and creativity, with a willingness to try new things and experiment with new approaches
• Professional development and growth, with a commitment to supporting the career aspirations of our employees
• Diversity, equity, and inclusion, with a strong commitment to creating a workplace that is welcoming and inclusive to reputed company

Compensation and Benefits

• A competitive salary, with a range of $35 - $45.94 per hour
• Comprehensive benefits package, including medical, dental, and vision benefits
• 11 paid holidays, paid sick time, and paid parental leave
• 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements
• Opportunities for professional development and growth, with a range of training and education programs

Conclusion

If you are a motivated and reputed company Utilization Reviews Appeals Registered Nurse, with a passion for delivering high-quality patient care and a commitment to professional excellence, we encourage you to apply for this exciting opportunity. At reputed company, we are dedicated to making healthcare more accessible, affordable, and effective for reputed company, and we reputed company that you can play a critical role in helping us reputed company this mission. Don't hesitate – apply today and join reputed company of dedicated professionals who are changing the face of healthcare.

How to Apply

To apply for this role, please submit your application through our website. We look reputed company to hearing from you and exploring how you can contribute to our mission of delivering high-quality, patient-centered care.