Job Summary
A managed healthcare and insurance company is seeking a Remote Health Service Nurse.
Core Responsibilities Include:
- Working on preservice reviews on all referral requests
- Performing the initial review using InterQual criteria
- Elevating the case to the client Medical Director or Physician Reviewer if criteria is not met
Position Requirements Include:
- 3+ years of relevant work experience, in related clinical, managed healthcare or healthcare setting
- Experienced telehealth nurse, able to perform tasks associated with keeping service level agreements
- Experienced at working independently and once trained, without significant guidance
- Excellent understanding of health-service related processes relevant to assigned role and responsibilities
- Good knowledge of healthcare, government, and insurance industry trends
- Ability to interact with senior level clients, and high level of computer literacy
