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RN Reviewer

Posted 8 days agoViewed

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💎 Seniority level: Middle, Minimum of 3 years of clinical experience.

📍 Location: United States, EST, NOT STATED

💸 Salary: 32.0 - 35.0 USD per hour

🔍 Industry: Clinical intelligence

🏢 Company: Cohere Health👥 501-1000💰 $50,000,000 Series C 12 months agoSaaSConsumer SoftwareHealth CareSoftware

🗣️ Languages: English

⏳ Experience: Minimum of 3 years of clinical experience.

Requirements:
  • Registered Nurse with active, unencumbered license in state of residence.
  • Minimum 3 years of clinical experience.
  • Required Utilization Management experience.
  • Experience in acute care and/or post-acute care environments.
  • Preferred experience includes HEDIS RN/abstraction, Legal RN, Utilization Review.
  • Strong communication skills, both written and oral.
  • Understanding of NCQA and CMS standards.
  • Proficient in using MCG guidelines.
Responsibilities:
  • Performs medical necessity review including inpatient, concurrent, prior authorization, retrospective, and treatment setting reviews.
  • Consults with Medical Directors regarding care that does not meet criteria.
  • Documents clinical information accurately and timely.
  • Maintains understanding of Cohere Health’s authorization and clinical criteria.
  • Identifies and refers members to appropriate healthcare programs.
  • Collaborates and educates with various stakeholders to ensure criteria consistency.
  • Ensures compliance with accreditation and regulatory requirements.
  • Participates in quality improvement activities.
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🔥 Weekend RN Reviewer
Posted 8 days ago

📍 United States

💸 33.0 - 35.0 USD per hour

🔍 Clinical intelligence

🏢 Company: Cohere Health👥 501-1000💰 $50,000,000 Series C 12 months agoSaaSConsumer SoftwareHealth CareSoftware

  • Registered Nurse with active, unencumbered license in the state of residence.
  • Minimum of 3 years of clinical experience.
  • Utilization Management experience is required.
  • MCG certification is preferred.
  • Experience in acute or post-acute care environments is desired.
  • Understanding of NCQA and CMS standards.
  • Excellent written and oral communication skills.

  • Performs medical necessity review including inpatient, concurrent, prior authorization, and retrospective reviews to ensure appropriateness and compliance.
  • Communicates consistently with providers and facility staff to meet member needs.
  • Documents clinical information completely, accurately, and timely.
  • Maintains understanding of authorizations and clinical criteria.
  • Identifies clinical program opportunities and refers to healthcare programs.
  • Collaborates with various teams to ensure application of clinical criteria.
  • Ensures compliance with accreditation and regulatory requirements.
  • Supports quality improvement activities.
Posted 8 days ago
Apply

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