Physical Health Registered Nurse (Remote)

LOCATION : Remote - this a home based, virtual position that operates from Monday - Friday from 8 : 30am-5 : 00pm EST. Vaya Health welcomes applications from NC, SC, GA, TN, VA, MD, and FL.

GENERAL STATEMENT OF JOB

The Physical Health Registered Nurse is responsible for completing clinical reviews for appropriateness, medical necessity, and quality. The Physical Health Registered Nurse applies standardized clinical review criteria to determine medical necessity for service authorization requests. The Physical Health Registered Nurse refers service authorization requests to an appropriate physician peer reviewer when medical necessity criteria are not clearly met. Reviews performed by the individual in this position may be pre-service, concurrent, or retrospective in nature. This position is part of a team of nurses, physicians, psychologists, pharmacists and non-clinical associates who work closely to care for our members.

The day to day operations of the Physical Health Utilization Management Department require coverage on weekends and holidays. The incumbent in this position will be required to participate in a rotation to ensure coverage every day including weekends and holidays. The amount of work on scheduled weekends and holidays will be subject to change.

ESSENTIAL JOB FUNCTIONS

Process requests for authorization of services :

• Responsible for reviewing requests for authorization of services including inpatient hospital admissions, re-admissions, inpatient rehabilitation services, skilled nursing admissions, home care / home infusion services, outpatient and / or inpatient services as designated.
• Documents timely decisions and actions taken within the managed care information system (MCIS).
• Meets contractual timelines for completion of review activities
• Communicates and interacts with providers as well as internal and external partners to facilitate and coordinate the activities of the UM process.
• Utilizes technology (computer-based systems) and resources to support work activities appropriately.
• Communicates determinations to providers per established business process

Supporting UM Functions :

All other duties as assigned in support of UM functions.

KNOWLEDGE, SKILLS, & ABILITIES

This position requires a high degree of autonomy, professional relationships and organizational skills. Applicants with thorough knowledge of the following are prioritized :

Additional required skills and abilities include but are not limited to the following :

PHYSICAL REQUIREMENTS

QUALIFICATIONS & EDUCATION REQUIREMENTS

Associate Degree in Nursing required. Bachelor's Degree in Nursing preferred.

Licensure / Certification Required :

Active and unrestricted RN Licensed in the State of North Carolina or Nurse Licensure Compact (NLC) license.

RESIDENCY REQUIREMENTS : The person in this position must live in NC, SC, GA, TN, VA, MD, or FL.

SALARY : Depending on qualifications & experience of candidate. This position is exempt and is not eligible for overtime compensation.

DEADLINE FOR APPLICATION : Open Until Filled

APPLY : Vaya Health accepts online applications in our Career Center, please visit https : / / www.vayahealth.com / about / careers / .

Vaya Health is an equal opportunity employer.