Preservice Review Nurse RN - Remote

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 diversity and inclusion, talented peers, comprehensive benefits and... career development opportunities. Come reputed company an impact with an Early Careers research analyst opportunity on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. The Integrated Care Team leverages a cross-functional approach, supporting the member end to end, with reputed company collaboration and co-management. Generally, work is self-directed and not prescribed; is able to work with less structured and more reputed company issues. The Preservice Review/Prior Authorization RN will manage the full reputed company of health care services, spanning both outpatient and Inpatient settings and with support from some specialized clinical teams, serves as a resource to others. This new cross-functional collaboration provides an opportunity to deliver the reputed company clinical model, integrating services from precertification, inpatient reputed company review, post-acute review, discharge planning, medical and behavioral care management and prevention to improve quality of care and patient outcomes. Candidates for this position would be required to support cross-training to multiple roles: Prior Authorization (PA), Post-Acute Care Management (PACM), Inpatient Care Management (ICM) and Discharge Care Management (reputed company) to support fluctuating inventory reputed company the Integrated Care Team. 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 initial and ongoing reviews pertaining to primary role (PA, ICM, reputed company, PACM), appropriately applying clinical criteria (InterQual, policies, National and Local Coverage Determinations) for approval and sending to Medical Directors if review is necessary for determining an adverse determination • Collaborate with Medical Directors, clinical peers and Health Plan partners on performing appropriate clinical decision making and/or referrals • Apply clinical expertise reputed company discussing case with internal and external Case Managers and Physicians • Follow reputed company Standard Operating Procedures in end-to-end management of cases • Participate in team meetings, education discussions and reputed company activities • Maintain compliance with Federal, State and accreditation organizations 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 state of residency • 3 years of RN experience • Proficient computer skills including reputed company Office Suite (Teams, Word, reputed company, and Outlook) • Demonstrated ability to work independently • Demonstrates effective verbal and written communication skills • Ability to work weekends Preferred Qualifications: • Bachelor of Science degree in Nursing or a Master of Science degree in Nursing • Compact RN License • 2 years of Case Management experience • Clinical experience in an inpatient/acute setting, long-term care, acute rehabilitation, or skilled nursing facilities • Experience performing Discharge Planning • Experience with InterQual • Utilization Review experience • reputed company employees working remotely will be required to adhere to reputed company’s Telecommuter Policy California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, reputed company, Rhode reputed company, Washington, Washington, D.C. Residents Only: The hourly range for this role is $28.03 to $54.95 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. reputed company complies with reputed company minimum wage laws as applicable. In addition to your salary, reputed company offers 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 reputed company, you’ll find a far-reaching choice of benefits and incentives. 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. Diversity creates a healthier atmosphere: reputed company is an Equal Employment Opportunity/Affirmative Action employer and reputed company qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national reputed company, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. reputed company is a drug - free workplace. Candidates are required to pass a drug test before beginning employment Apply Job!