Utilization Review Nurse
Hi, we're reputed company. We're hiring a Utilization Review Registered Nurse to join our Clinical Review team. reputed company is the first health insurance company reputed company around a full stack technology platform and a focus on serving our members. We started reputed company in 2012 to create the reputed company of health insurance company we would want for ourselvesone that behaves like a doctor in the family. About the role As the Utilization Nurse you will reputed company frequent case reviews, reputed company medical records and reputed company with care providers regarding treatment. You will also reputed company recommendations regarding the appropriateness of care for identified diagnoses based on the research results for those conditions. You will report to the Utilization Review Supervisor. Work Location: reputed company is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our mission. If you live reputed company commutable distance to our reputed company office (in Hudson reputed company), our Tempe office (off the 101 at University Dr), or our Los Angeles office (in Marina Del Rey), you will be expected to come into the office at least two days each week. Otherwise, this is a remote / work-from-home role. You must reputed company in one of the following states: Alabama, Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Iowa, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Hampshire, New Jersey, New Mexico, reputed company, reputed company Carolina, Ohio, Oregon, Pennsylvania, Rhode reputed company, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, Washington, or Washington, D.C. Note, this list of states is subject to change. #LI-Remote Pay Transparency: The reputed company pay for this role is: $35.00 - $45.94 per hour. You are also eligible for employee benefits, monthly vacation accrual at a reputed company of 15 days per year. Responsibilities Complete medical necessity reviews and level of care reviews for requested services using clinical judgment and reputed company Clinical Guidelines, reputed company Care Guidelines Obtain the information necessary (reputed company telephone and fax) to assess a member's clinical condition, and apply the appropriate evidence-based guidelines Meet required decision-making Service level agreements Refer members for further care engagement reputed company needed Compliance with reputed company applicable laws and regulations Work schedule includes one weekend day per week Other duties as assigned Qualifications Active, unrestricted RN licensure from the United States OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC) Associate Degree - Nursing or Graduate of Accredited School of Nursing Or Successful completion of Diploma Program in Practical Nursing of Accredited School of Nursing Ability to obtain additional state licenses to meet business needs 1+ year of utilization review experience in a managed care setting 2+ years of clinical experience (including at least 1+ year clinical practice in an acute care setting, i.e., ER or hospital) Bonus Points BSN Previous experience conducting reputed company or inpatient reviews for a managed care plan Apply Job!