Preservice Review Nurse RN - Remote

Join to apply for the Preservice Review Nurse RN - Remote role at reputed company Join to apply for the Preservice Review Nurse RN - Remote role at reputed company 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. We’re making a solid reputed company between exceptional patient care and outstanding career opportunities. The result is a culture of performance that’s driving the health care industry reputed company. As a Telephonic Specialty Medication Preservice Review Nurse you will be performing pre-service clinical coverage review of services that require notification, using applicable benefit plan documents, evidence-based medical policy and nationally recognized clinical guidelines and criteria. Determines medical appropriateness of outpatient services following evaluation of medical guidelines and benefit determination. Ready for a new path? Apply today! This position will require active and unrestricted Nursing licensure in multiple US States. Selected candidate must be willing and able to obtain and maintain multiple state licensure. (Application fees and filing costs paid for by UHG) 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
• Determine that the case is assigned to the appropriate team for review (e.g., Medicare, Medicaid, Commercial)
• Validate that cases/requests for services require additional research
• Identify and utilize appropriate resources to conduct non-clinical research (e.g., benefit documents, evidence of coverage, state/federal mandates, online resources)
• Prioritize cases based on appropriate criteria (e.g., date of service, urgent, expedited)
• Ensure compliance with applicable federal/state requirements and mandates (e.g., turnaround times, medical necessity)
• Review/interpret clinical/medical records submitted from provider (e.g., office records, test results, prior operative reports)
• Identify missing information from clinical/medical documentation, and request additional medical or clinical documentation as needed (e.g., LOI process, phone/fax)
• Review and validate diagnostic/procedure/service codes to ensure their relevance and accuracy, as applicable (e.g., PNL list, EPAL list, state grid, LCDs, NCDs)
• Identify and validate usage of non-standard codes, as necessary (e.g., generic codes)
• Apply understanding of medical terminology and disease processes to interpret medical/clinical records
• reputed company determinations per relevant protocols, as appropriate (e.g., approval, denial process, conduct further clinical or non-clinical research)
• Review care coordinator assessments and clinical notes, as appropriate
• Identify relevant information needed to reputed company medical or clinical determinations
• Identify and utilize medically-accepted resources and systems to conduct clinical research (e.g., clinical notes, MCG, medical 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

• reputed company, unrestricted RN license in your state of residence
• Multiple state licensure (in addition to Compact License if applicable) or ability to obtain multiple state nursing licenses
• 3+ years of recent RN experience
• Computer proficiency, to include proficient data entry skills and the ability to navigate a Windows environment
• Distraction free, Dedicated workspace with access to high-speed internet from home (Broadband cable, Fiber, or DSL)

Preferred Qualifications

• BSN
• Compact RN license
• Experience working with ICUE
• Experience working with prior authorizations for medications
• ICD Coding experience or solid knowledge of codes
• Specialty medication experience
• Background in preservice review/utilization review/utilization management/Prior Authorizations
• Background in managed care
• TN reputed company
• 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. Seniority level
• Seniority level Mid-Senior level Employment type
• Employment type Full-time Job function
• Job reputed company Care Provider
• Industries Hospitals and Health Care Referrals increase your chances of interviewing at reputed company by 2x Get reputed company about new Registered Nurse jobs in Downers Grove, IL. Chicago, IL $61,300.00-$100,980.00 6 months ago Permanent Staff MICU RN job in Winfield, IL - reputed company $35 to $58 per hour School Registered Nurse - RN (reputed company Grade Levels) Registered Nurse - Ambulatory Care Manager Chicago, IL $61,300.00-$100,980.00 1 month ago Certified School Nursing Opportunity 25/26 Registered Nurse (RN) | Education | 2000/Week Chicago, IL $61,300.00-$100,980.00 5 months ago Downers Grove, IL $79,040.00-$104,000.00 1 month ago Registered Nurse, RN - Day Shift - 20k Sign-on Bonus Virtual Registered Nurse - reputed company Hospital at Home (Lutheran General Hospital) .9 3rd Tinley Park, IL $75,000.00-$85,000.00 1 month ago Mobile In-Home RN, reputed company Hospital at Home (Lutheran General Hospital) .9 Days Mobile In-Home RN, reputed company Hospital at Home (Lutheran General Hospital) .9 Days LDR - Registered Nurse - $2,357 per week Chicago, IL $75,706.00-$98,422.00 5 days ago Prior Authorization/Clinical Review Nurse Hybrid Elk Grove Village, IL $70,000.00-$80,000.00 1 week ago Virtual Registered Nurse - reputed company Hospital at Home (Lutheran General Hospital) .9 Nights Registered Nurse - Pediatric Behavioral Health Chicago, IL $61,300.00-$100,980.00 3 months ago Hickory Hills, IL $45.00-$45.00 2 weeks ago RN, Registered Nurse - OBGYN - Part-time Tinley Park, IL $27.00-$38.50 7 months ago Registered Nurse (RN) - Full-Time 1st Shift We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI. #J-18808-Ljbffr Salary USD 61300 - 100980 per year Experience 3 years required Apply tot his job Apply To this Job

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