Job Description

Essential Qualifications:

Valid Registered Nurse (RN) license in your state of residence. Open to applicants from the following states: Alabama, Arizona, California, Colorado, Connecticut, DC, Florida, Georgia, Illinois, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, Washington.
4-5 years of experience in remote Utilization Management, working directly with health insurance payors (not third-party companies).
Experience using Milliman Care Guidelines (MCG).
Proficient in Google Suite applications (Google Sheets, Calendar, etc.).
Comfortable using a MacBook and navigating a remote work environment, including setting up a workstation and using a VPN.
Strong problem-solving skills and the ability to think critically and troubleshoot independently.
Position Overview:

We are seeking a dedicated and detail-oriented Pre-Access Utilization Management Registered Nurse to join our team in a fully remote role. In this position, you will evaluate patient care requests, collaborate with healthcare providers, and help ensure that services, such as surgeries, procedures, and hospital admissions, align with medical necessity.

Your day-to-day responsibilities will involve reviewing and assessing patient care requests, working closely with doctors and other healthcare professionals to ensure appropriate care plans, and maintaining confidentiality and privacy in accordance with company policies. You'll be expected to process approximately two patient cases per hour, so attention to detail and time management are key.

This role requires someone who can work both independently and collaboratively, is flexible, and can adapt to changes in a dynamic work environment. A strong command of the plan and benefit template, as well as excellent written and verbal communication skills, are essential for success in this role.
Employment Type: Full-Time
Salary: $ 40.00 44.00 Per Hour

Job Tags

Hourly pay, Full time, Flexible hours,

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