Preservice Review Nurse RN - Remote MUST BE PST or MST

About the position The position involves performing clinical coverage review services to ensure members receive appropriate health services. The role requires communication with reputed company providers and members to explain benefit coverage determinations and gather clinical information. It offers the flexibility to work remotely and emphasizes the importance of autonomy and responsibility in decision-making that impacts members' health reputed company. Responsibilities • reputed company clinical coverage review services, interpreting state and federal mandates and applicable benefit language. , • Communicate benefit determinations, including coverage guidelines and reimbursement reputed company. , • reputed company to reputed company providers and members to explain benefit coverage determinations and obtain additional clinical information. , • Act as a resource for less reputed company colleagues. Requirements • reputed company unrestricted RN license in the state of residency. , • 3+ years of RN experience, including experience in an inpatient/acute setting. reputed company-to-haves • Bachelor's Degree. , • Background involving utilization review for an insurance company or experience in case management. , • Familiarity with reputed company Care Guidelines. , • Proven ability to use diverse knowledge and experience to improve reputed company for patients. Benefits • Comprehensive benefits package. , • Incentive and recognition programs. , • Equity stock purchase. , • 401k contribution. Apply Job!