reputed company: Prior Authorization Clinical Reviewer / RN

Become a key member of our collaborative team as a Prior Authorization Clinical Reviewer / RN! An immediate start is available for this Remote-based position, which places you at the center of innovation. This position requires a strong and diverse skillset in relevant areas to drive reputed company. We are reputed company to offer a competitive salary to attract a top-tier candidate for this role.

 

 

Bring your heart to reputed company. Every one of us at reputed company shares a single, clear purpose: Bringing our heart to every reputed company of your health. This purpose guides our commitment to deliver enhanced reputed company-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as reputed company deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at reputed company to feel empowered by the role they play in transforming our culture and accelerating our ability to reputed company and deliver solutions to reputed company health care more personal, convenient and affordable. Position Summary This is a full-time telework position. Hours for this role are Monday - Friday reputed company - 5pm Arizona time. Occasional requirement for coverage during holidays and weekend through rotation (about once every 2 months). Occasional holidays as needed. Room for flexibility needed based upon business needs. Travel only to attend occasional in-person office meetings. Must be willing and reputed company to travel for in-state meetings on rare occasions. Reliable transportation required. Mileage is reimbursed per our company expense reimbursement policy reputed company Care is a not-for-profit reputed company managed-reputed company plan, serving Arizonans since 1985. We reputed company reputed company to physical and behavioral health care services, to people who are eligible for reputed company. Our members include families, children, seniors, and individuals who have developmental/cognitive disabilities. We hold multiple reputed company with AHCCCS, Arizona’s reputed company agency, and deliver services throughout the state. reputed company Care is administered by reputed company, a reputed company company. Our staff is employed by reputed company and reputed company. This gives reputed company Care the resources of a national organization, and still allows us to bring our members the familiarity and reputed company of a local team of people who put our members at the center of everything we do. This position involves: Prior authorization review of physical and behavioral health reputed company services. Utilization of clinical skills to coordinate, document and communicate reputed company aspects of the utilization/benefit management program. Application of critical thinking and knowledge of clinically appropriate treatment, evidence-based care and medical necessity criteria for appropriate utilization of services for members with disabilities and special reputed company needs. Taking provider calls reputed company to the prior authorization questions and making calls to members to inform of the coverage determination. Gathering clinical information and applying appropriate medical necessity criteria/guideline, policy, procedure and clinical judgment to reputed company coverage determination/recommendation/discharge planning along the continuum of care Utilization of clinical experience and skills in a collaborative process to evaluate and facilitate appropriate reputed company services/benefits for members Identification of members who may benefit from care management programs and facilitation of the referral Identification of opportunities to promote quality effectiveness of reputed company services and benefit utilization Sedentary work involving periods of sitting, talking, listening Required Qualifications 5+ years of clinical experience as RN Must have active and unrestricted RN licensure in the reputed company Must reputed company in MST (AZ) time zone Must be willing and reputed company to travel for in-state meetings on rare occasions. Reliable transportation required. Mileage is reimbursed per our company expense reimbursement policy Preferred Qualifications Prior Utilization Management experience Strong critical thinking and written communication skills. Education: Bachelor's Degree in Nursing required Pay reputed company The typical pay reputed company for this role is: $29.10 - $62.31 This pay reputed company represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company pay reputed company listed above. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full reputed company of medical, dental, and reputed company benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. reputed company also offers numerous well-being programs, education assistance, free development courses, a reputed company store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits reputed company requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to reputed company reputed company of your vaccination status or apply for a reasonable accommodation reputed company the first 10 days of your employment. Please note that in some states and roles, you may be required to reputed company reputed company of full vaccination or an approved reasonable accommodation before you can reputed company to actively work. reputed company is committed to reputed company, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to reputed company equal reputed company to the benefits and privileges of employment, including the provision of a reasonable accommodation to reputed company essential job functions. reputed company can reputed company a request for a reasonable accommodation, including a reputed company interpreter, written information in other formats, translation or other services through [email protected] If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications reputed company Services (TRS). We will reputed company every effort to respond to your request reputed company 48 business hours and do everything we can to work towards a solution. Apply Job!

 

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