Preservice Review Nurse RN

Job Summary

A company is looking for a Preservice Review Nurse RN - Remote who will ensure members receive proper health services through clinical coverage reviews.

Key Responsibilities

• Perform clinical coverage review services, interpreting mandates and clinical information
• Communicate benefit determinations and explain coverage decisions to healthcare providers and members
• Act as a resource for less experienced staff while managing autonomous decision-making responsibilities

Required Qualifications

• Current unrestricted RN license in the state of residency
• 3+ years of RN experience, including inpatient/acute setting experience
• Designated homework space and access to secure high-speed internet
• Preferred Bachelor's Degree and experience in utilization review or case management
• Familiarity with Milliman Care Guidelines is a plus