RN Clinical Care Manager

Job Summary

A company is looking for a Global Insurance Clinical Care Manager - RN - Remote.

Key Responsibilities:

• Perform prospective, concurrent, and retrospective reviews for Global Expat members
• Communicate with members and providers to gather necessary information for clinical reviews
• Assist Clinical Health Managers with pre-admission and post-discharge member outreach and participate in fraud investigations

Required Qualifications:

• Registered Nurse with an active unrestricted United States license
• 3+ years of experience in medical-surgical inpatient acute care
• Experience in Clinical Coverage Review, Medical Claim Review, or Clinical Appeals
• Ability to work in the Eastern time zone and adjust schedule as needed
• Demonstrated cultural competence and awareness of global healthcare delivery challenges