Telephonic Registered Nurse Clinical Reviewer
New
Remote, Monday- Friday 12:30pm-9:00 pm ESTFull-TimeMiddle
Salary31 - 52 USD / hourly
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Job Details
- Experience
- 1 year of acute care, managed care, ER, ICU experience or 2 years of clinical utilization management experience
- Required Skills
- MS OfficeHIPAA
Requirements
- Associate's Degree in Nursing.
- Current, unrestricted RN license in state of primary residence.
- Minimum 1 year of acute care, managed care, ER, or ICU experience OR 2 years of clinical utilization management experience.
- Advanced proficiency in MS Office applications.
- Excellent verbal and written communication skills.
- Excellent problem-solving and customer service skills.
- Ability to multi-task and work self-directed.
- Ability to hear and speak on the phone for an entire shift.
- Must be able to sit through entire shift.
- Cable broadband or fiber optic internet service with at least 10Mbps download/5Mbps upload speeds.
Responsibilities
- Evaluate telephone, fax, or WEB requests for authorization of clinical services.
- Compare requests against established clinical protocols to authorize services or refer for expert review.
- Issue review determinations based on clinical information submitted by providers.
- Maintain current departmental productivity standards.
- Prepare program correspondence and make outbound calls as required.
- Serve as a resource for members and handle provider/member complaints or appeals.
- Run and analyze reports to ensure timely completion of tasks.
- Assist team members in departmental chats, by phone, and in person.
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