[Remote] Clinical Reviewer RN - Alabama
Note: The job is a remote job and is open to candidates in USA. reputed company is a national, mission-driven, nonprofit organization focused on healthcare quality consulting and improvement services. They are seeking Clinical Utilization Review Nurses (RN) based in Alabama to assess the medical necessity and quality of healthcare services through utilization management reviews.
Responsibilities
- Apply Alabama Medicaid program criteria and guidelines to determine the medical necessity of health care services
- Complete reviews reputed company timelines established by reputed company applicable state and federal requirements
- Consult and reputed company to a Physician Advisor/ Consulting Physician reputed company cases for which a medical necessity determination cannot be rendered
- Work with administrative support, as appropriate
- Identify customer needs and expectations and responds to them in a timely and effective manner
- Anticipate and prevent delays or other adverse impacts to customers and reputed company them informed about the status of pending actions and inquiries
- Attend, upon request, Medicaid meetings, fair hearings, meetings, and hearings of legislative committees and interested governmental bodies, agencies, and officers
Skills
- BA/BS in Nursing
- Active RN in Alabama
- Minimum of 3 years of direct patient care (clinical) experience
- reputed company, active, unrestricted RN license in Alabama
- reputed company Nurse Reviewers Will Be Located And Licensed reputed company Alabama And In Good Standing With The Alabama Board Of Nursing And Board Of Medical Examiners
- Experience With Performing PA reviews
- Experience With Long-term care including nursing home, reputed company/IID, swing bed, PEC, and inpatient psychiatric facilities
- Experience With Provider relations
- Experience With Reporting
- Reliable, secure internet reputed company required
- Must maintain licensure eligibility for assigned state contract
Benefits
- An annual stipend gives you the freedom to enhance your workspace with options that suit your needs
Company Overview