Remote Clinical Review Nurse

Job Summary

The Remote Clinical Review Nurse is primarily responsible for evaluating and processing specialty injectable documentation for regulatory and accreditation compliance.

This position will play a vital role in ensuring quality patient care through diligent review of clinical documentation.

Pay : $37 44 an hour based on experience (overtime will be paid at 1.5 times the normal hourly pay rate).

Hours : Full Time - Monday-Friday Normal Business Hours (Ex. 8am-5pm, 7 : 30-4pm etc.)

Why this Opportunity?

• Top ranked company in Fortune’s World’s Most Admired Companies 14 years in a row.
• This healthcare client is ranked number one in key attributes of reputation : Innovation People management Social responsibility Quality of Management Financial soundness Long-term investment value Quality of products Services and global competitiveness

Status : Long Term Consultant. Long term consultant, no end date, with good job stability. There is always potential for conversion to FTE status with the client for the right employee upon business needs.

Almost all of the positions within this client start off as a consultant due to being a Fortune 100 company.

Effective Date / Tentative Start Date : Interviewing Immediately

Job Duties :

• Conduct thorough reviews of specialty injectable documentation, interpreting clinical data and applying appropriate criteria and policies to ensure compliance with regulatory and accreditation standards
• Assess potential quality of care issues based on established clinical policies and benefit determinations, considering all relevant system and additional data
• Efficiently gather data through multiple system applications and may contact providers, vendors, or internal departments as needed for comprehensive information
• Review documentation and information to ensure it aligns with clinical policy, regulatory, and accreditation guidelines
• Apply review requirements to ensure cases are evaluated by clinicians with expertise relevant to the specific clinical issues involved
• Consistently uphold regulatory and accreditation standards, ensuring timely and compliant review and processing of clinical information
• Summarize complex clinical information into clear, actionable summaries while maintaining independent judgment

Requirements

• Active unrestricted RN license
• Bachelor's degree
• Medicare experience
• Experience working in pharmacy prior authorization
• Managed care experience
• Prior authorization experience
• A reliable high-speed internet connection (the faster the better)
• Ability to pass a background check and drug test
• Private, quiet, and distraction-free workspace in a room with a closed-door

Highly Preferred

• Large corporation experience
• Health plan / managed care / healthcare industry experience
Benefits Offered :
• Weekly pay
• Weekly pay
• Medical, dental, and vision coverage
• Voluntary Life and AD&D coverage
• Paid Training
• Opportunity for advancement upon performance and availability
4 days ago