Preservice Review Nurse - Remote
$60,320–$108,160 year
RemoteUnited States or Nevada, United States
Job Summary
Evaluate and assess provider requests for eligibility, benefit levels, and contractual status using approved Milliman Care Guidelines. Determine if cases meet medical necessity to approve, pend, or send to the medical director for review. Maintain at least 98% accuracy in clinical review case notes and summaries within Facets while adhering to strict turnaround times and regulatory compliance standards. Act as a resource to new staff and precept as needed. This role requires a current, unrestricted Nevada RN license with 2+ years of critical care, ER, or med-surg experience, working Monday through Friday from 8:00 am to 5:00 pm PST remotely.
Required Qualifications
- A current, unrestricted RN license for the state of Nevada
- 2+ years of recent critical care, ER and/or med-surg nursing experience
- Proficient with Microsoft Word to create, edit, save and send documents
- Ability to navigate a Windows environment, Microsoft Outlook, and conduct Internet searches
- Must be available to work Monday - Friday from 8:00 am - 5:00 pm PST
- Must be able to work remotely from anywhere within the U.S.
- Candidates are required to pass a drug test before beginning employment
Desired Qualifications
- 2+ years Utilization Management experience in managed care, acute or rehab setting
- Knowledge of utilization review process and prior authorization process in a managed health care industry
- Knowledge of ICD9 / CPT coding and Milliman Care Guidelines
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