Job Summary
A managed healthcare and insurance company is searching for a person to fill their position for a Remote Clinical Policies and Guidelines Registered Nurse.
Core Responsibilities Include:
- Researching product-specific clinical utilization management guidelines
- Planning and executing annual expert panel
- Conducting quality of care investigations
Position Requirements Include:
- Bachelor’s Degree in Nursing (BSN) or related field
- Active, unrestricted Registered Nurse (RN) license
- Certification as a medical coder through AAPC or AHIMA or willingness to obtain
- 3+ years of experience with researching, developing, and writing medical policies
- 3+ years of experience providing case management services
- Medical-surgical clinical experience
