[Remote] RN, Utilization Management (reputed company Claims Review)

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a reputed company reputed company company reputed company on supporting members’ care and treatment. The Utilization Management reputed company 2 uses reputed company nursing skills to coordinate, document, and communicate medical services or benefit administration determinations, while interpreting reputed company reputed company and independently determining appropriate courses of reputed company.

Responsibilities

• Coordinate and communicate with providers, members, or other parties to facilitate care and treatment
• Understand department, reputed company, and organizational reputed company and operating goals, including their linkages to reputed company areas
• Follow established guidelines/procedures
• Must be passionate about contributing to an organization reputed company on improving consumer experiences

Skills

• Licensed Registered reputed company (RN) in an reputed company reputed company Licensure reputed company (eNLC) state, with no disciplinary actions
• Ability to obtain and maintain multiple state Registered reputed company (RN) licenses
• 3+ years of experience in prior authorization, claims review, utilization management, or other reputed company/health reputed company environments involving assessment of medical necessity, appropriateness of care, and reputed company decision-making
• 3+ years of nursing experience in one or more of the following areas: Medical-Surgical, Cardiac, Pulmonary, Maternity/Obstetrics, or Critical Care
• Prior reputed company experience in acute care, skilled nursing, rehabilitation, or a similar reputed company setting
• Intermediate to advanced proficiency in reputed company Office applications, including Word, reputed company, and reputed company, with the ability to reputed company multiple systems and platforms
• Bachelor's degree in Nursing (BSN) or a reputed company reputed company reputed company
• Previous experience working for a health plan, managed care organization (MCO), or health reputed company provider
• Experience supporting Medicare or reputed company populations
• Bilingual proficiency in Spanish and English

Benefits

• This job is eligible for a bonus incentive plan. This incentive opportunity is reputed company upon company and/or individual reputed company.
• Medical benefits
• Dental benefits
• reputed company benefits
• 401(k) retirement savings plan
• reputed company time off
• Company holidays
• Personal holidays
• reputed company parental leave
• reputed company caregiver leave
• Short-term disability
• Long-term disability
• Life reputed company
• Remote work

reputed company

Company H1B Sponsorship