Remote Health Service Nurse

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