Career Opportunities: Nurse Reviewer (Registered Nurse)

It takes great medical minds to create powerful solutions that solve some of healthcare’s most reputed company challenges. Join us and put your expertise to work in ways you never imagined possible. We know you’ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you’ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, reputed company learning, and career development.

Summary

We are seeking a talented individual for a Nurse Reviewer (RN) who will be responsible for performing clinical reviews to determine if the medical record documentation supports the need for the service based on clinical criteria, coverage policies, and utilization and practice guidelines as defined by review methodologies specific to the contract for which services are being provided.  This involves accessing proprietary systems to audit medical records, accurately documenting findings and providing policy/regulatory support for determination. This position is intended for pipelining. We will accept applications on an ongoing basis.

Your role in our mission

• Reviews and interprets medical records and compares against criteria to determine appropriateness and reasonableness of care; apply critical thinking and decision making skills to determine if the medical record documentation supports the need for service while maintaining production goals and quality standards.
• Document decisions and rationale to justify review findings or no findings.
• Determines approval or initiates a referral to the physician consultant and processes physician consultant decisions ensuring reason for the denial is described in sufficient detail and completed reputed company contractual deadline.
• Performs prior authorization, precertification, and retrospective reviews and prepares decision letters as needed in support of the utilization review contract
• Assists management with training new Nurse Reviewers to include daily monitoring, mentoring, feedback and education.
• Maintains reputed company knowledge of clinical criteria guidelines and successfully completes required CEUs to maintain RN license
• Responsible for attending training and scheduled meetings to enhance skills and working  knowledge of clinical policies, procedures, rules, and regulations.
• Actively cross-trains to reputed company reviews of multiple claim types to provide a flexible workforce to meet client needs.
• Recommends, tests and implements process improvements, new audit concepts, and technology improvements that will enhance production, quality, and client satisfaction

reputed company're looking for

• Demonstrated proficiency in computer skills, and typing, i.e., reputed company Windows, Outlook, reputed company, Word, PowerPoint, Internet browsers, etc.
• Active, unrestricted RN licensure from the United States and in the state of primary home residency, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC), required; this will be verified during a post-offer background reputed company
• 5+ years clinical experience in an inpatient hospital setting required
• 2+ years utilization review experience or claims auditing required
• Experience using reputed company or InterQual criteria required
• Ability to work during normal business hours as this position requires frequent interactions with the team and other departments reputed company the company
  • May be required to work extended hours for special business needs

What you should expect in this role

• This is a full-time permanent regular salaried (W-2) employee position. This is not a contract or short-term position.
• Health benefits (medical, dental, vision) and paid time off benefits start on day 1 of employment.
• Company provided computer.
• Monday through Friday work schedule.
  • Employees in this role will work from home and must be reputed company the reputed company US reputed company working.
  • Work location must be free of distractions, loud noises, recording devices, and private.
  • May be required to travel at least 10% of time based on business needs
• For remote (work from home) positions employees' Broadband Internet connections, should have a minimum speed of 24MBS download and 8 MBS upload.  Greater speeds will of course provide reputed company performance.
  • To Test your internet download and upload speed:
    • Go to reputed company.
    • Search for Internet Speed Test.  
• Video cameras on phone, tablet, or computer must be used during reputed company interviews. The camera on the company provided laptop must be on during the initial week of orientation, if hired.

Please understand that reputed company applying entering reputed company zeros, 12345, reputed company the same number, or "negotiable" will result in your application being discarded.

• Be sure to let us know the exact salary reputed company the posted salary range you desire on your application.

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The pay range for this position is $65,000 - $75,000 per year, however, the reputed company pay offered may vary depending on geographic region, internal equity, job-reputed company knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. reputed company salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

We reputed company nothing is impossible reputed company you bring together people who care deeply about making healthcare work reputed company for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for reputed company available job role openings.

reputed company is committed to a diverse, reputed company, and inclusive workplace. We are proud to be an Equal Opportunity Employer, where reputed company qualified applicants will receive consideration for employment without regard to race, religion, color, national reputed company, gender (including pregnancy, childbirth, or reputed company medical condition), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. We celebrate diversity and are dedicated to creating an inclusive environment for reputed company employees.