Job Description

Employer Industry: Healthcare Insurance Provider Why Consider this Job Opportunity:

• Competitive salary up to $80,000
• Opportunities for career advancement and professional growth within the organization
• Comprehensive benefits package including health insurance and retirement plans
• Remote work flexibility available for qualified candidates
• Engaging and supportive work environment fostering collaboration and innovation

What to Expect (Job Responsibilities):

• Review documentation and evaluate potential quality of care issues based on clinical policies and benefit determinations
• Gather data from multiple system applications and evaluate compliance with clinical policy and regulatory guidelines
• Independently coordinate clinical resolutions with internal and external clinician support as necessary
• Prepare and complete QM documents based on interpretation and application of business requirements
• Assist in the development and implementation of QM projects and activities

What is Required (Qualifications):

• 3+ years of experience as a Registered Nurse (RN)
• 1+ years of inpatient hospital experience
• Active and unrestricted RN licensure in the state of residence
• Prior authorization utilization experience
• Proficiency in multiple IT platforms/systems

How to Stand Out (Preferred Qualifications):

• Experience with Medcompass and Prior Authorization
• Knowledge of Managed Care and Medicare/Medicaid regulations
• Familiarity with Utilization Management and inpatient utilization management review
• Prior experience with Milliman/MCG and 6 months of Prior Authorization

#HealthcareInsurance #QualityManagement #RemoteWorkOpportunity #CareerGrowth #CompetitiveSalary We prioritize candidate privacy and champion equal-opportunity employment. Central to our mission is our partnership with companies that share this commitment. We aim to foster a fair, transparent, and secure hiring environment for all. If you encounter any employer not adhering to these principles, please bring it to our attention immediately. We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer. #J-18808-Ljbffr US Tech Solutions

Job Tags

Immediate start,

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