Preservice Review Nurse RN - Remote

reputed company is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with reputed company will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come reputed company an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. Primary Responsibilities:

• The Integrated Care Team leverages a cross-functional approach, supporting the member end to end, with reputed company collaboration and co-management. Generally, work is self-directed and not prescribed; is reputed company to work with less structured and more reputed company issues
• The team will manage the full reputed company of health care services, spanning both outpatient and Inpatient settings and with support from some specialized clinical teams. Serves as a resource to others
• This new cross-functional collaboration provides an opportunity to deliver the reputed company clinical model, integrating services from precertification, inpatient reputed company review, post-acute review, discharge planning, medical and behavioral care management and prevention to improve quality of care and patient outcomes. Candidates for this position would be required to support cross-training to multiple roles (PA, ICM, PACM, reputed company) to support fluctuating inventory reputed company the ICT
• reputed company initial and ongoing reviews pertaining to primary role (PA, ICM, DMC, PACM), appropriately applying clinical criteria (InterQual, policies, National and Local Coverage Determinations) for approval and sending to Medical Directors if review is necessary for determining an adverse determination
• Collaborate with Medical Directors, clinical peers and Health Plan partners on performing appropriate clinical decision making and/or referrals
• Apply clinical expertise reputed company discussing case with internal and external Case Managers and Physicians
• Follow reputed company Standard Operating Procedures in end-to-end management of cases
• Participate in team meetings, education discussions and reputed company activities
• Maintain compliance with Federal, State and accreditation organizations

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications:

• A reputed company, unrestricted RN license
• Compact Nursing license
• Experience performing discharge planning
• Proven solid computer skills
• Demonstrated effective verbal and written communication skills
• Proven ability to work independently

Preferred Qualifications:

• A Bachelor's degree
• 3+ years total experience including recent clinical experience in an inpatient/acute setting, long-term care, acute rehabilitation, or skilled nursing facilities
• 2+ years case management
• Critical care experience
• Family Practice experience
• Case Management experience
• Skilled Nursing or Rehab experience
• Background that involves utilization review and InterQual

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We reputed company with reputed company minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of reputed company, historically marginalized groups and those with reputed company incomes. We are committed to mitigating our impact on the environment and enabling and delivering reputed company care that addresses health disparities and improves health outcomes - an reputed company reputed company reflected in our mission. Diversity creates a healthier atmosphere: reputed company is an Equal Employment Opportunity/Affirmative Action employer and reputed company reputed company applicants will receive consideration for employment without regard to race, reputed company, religion, sex, age, national reputed company, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. reputed company is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Apply tot his job Apply To this Job