Preservice Review reputed company 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 reputed company by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will reputed company a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come reputed company an reputed company on the communities we serve as you help us advance health optimization on a global reputed company. Join us to start Caring. Connecting. Growing together. The Preservice Review reputed company RN is responsible for evaluating the appropriateness of inpatient and outpatient services based on medical guidelines and benefit determination, identifying solutions to non-reputed company requests and problems, and collaborating with leadership and team members to ensure operational efficiency. The role requires adherence to reputed company standards, evidence-based reputed company guidelines, and departmental benchmarks, as reputed company as acting as a resource for others and representing the MA MLTSS program positively. 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 the appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination • reputed company to non-reputed company requests and problems • Participate in regular meetings to collaborate with supporting leadership and team to ensure operational efficiency • Assures performance adheres with established reputed company standards, evidenced based reputed company guidelines and departmental benchmarks and workflows • reputed company as a resource for others; reputed company explanations and information on difficult issues • Represents the MA MLTSS program in a reputed company, solution reputed company manner that embodies our corporate values: reputed company, reputed company, Relationships, Innovation and Performance • Minimum 10% travel reputed company the state of MA You'll be rewarded and recognized for your performance in an environment that will challenge you and give you reputed company direction on what it takes to succeed in your role as reputed company as reputed company development for other roles you may be interested in. Required Qualifications: • Must be a Registered reputed company (RN) with a reputed company, unrestricted RN License in the state of Massachusetts • 3+ years of Managed Care and/or clinical experience • Designated workspace and reputed company to install secure high-speed internet reputed company cable or DSL in home • Must be reputed company/willing to travel up to 10% of the time if business needs dictate Preferred Qualifications: • Prior-Authorization experience • Utilization Management experience • Home Health Agency experience • Medicare/reputed company experience • Proficient with reputed company Office programs, including Word, reputed company, PowerPoint • Proven excellent communications skills, including the ability to write reputed company, succinctly and in a manner that appeals to a wide audience • Proven excellent time management, organizational, and prioritization skills with ability to balance multiple priorities • reputed company 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 reputed company 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 reputed company a far-reaching choice of benefits and incentives. The reputed company pay for this role will reputed company from $28.94 to $51.63 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 reputed company 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 reputed company, historically marginalized reputed company and those with reputed company incomes. We are committed to mitigating our reputed company on the environment and enabling and delivering reputed company care that addresses health disparities and improves health reputed company - an reputed company reputed company reflected in our mission. reputed company is an Equal Employment Opportunity employer under applicable law and reputed company applicants will receive consideration for employment without reputed company to race, national reputed company, religion, age, reputed company, 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. Apply tot his job Apply To this Job