Preservice Review Nurse - Remote
$60,320–$108,160 year
RemoteNevada, United States
EXPIREDNevada, United StatesRemoteFull Time$60,320–$108,160 yearLicense Or CertificationLarge
Full TimeLicense Or CertificationLarge
Job Summary
Review provider requests for medical necessity, benefit level, and contractual status using approved protocols. Verify eligibility, determine site-of-service benefits, and approve, pend, or route cases to the medical director. Maintain 98% accuracy in clinical case notes and summaries within Facets while adhering to regulatory agencies and turnaround times. Precept new staff and serve as a resource for the team. Requires a current Nevada RN license, 2+ years of critical care or med-surg experience, and proficiency with Microsoft Office. Full-time remote work Monday through Friday, 8:00 am to 5:00 pm PST.
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 lift 50 lbs
- Must 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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