Clinical Claims Review RN - Remote

reputed company is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with reputed company will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come reputed company an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. The schedule is Monday - Friday during standard business hours in the local time zone. Flexibility reputed company those hours may be offered after training. This is a non-exempt (hourly) position that is overtime eligible based on business needs. You’ll enjoy the flexibility to work remotely

• from reputed company reputed company the U.S. as you take on some tough challenges.

Primary Responsibilities: • reputed company clinical coverage review services which require interpretation of state and federal mandates, applicable benefit language, and consideration of relevant clinical information • Function as a member of a self-directed team to meet specific individual and team performance metrics • Communicate in writing and verbally reputed company types of benefit determinations including reputed company regarding coverage guidelines, contractual limitations, and reimbursement determinations • Participate in telephonic discussions with health care providers and/or members to explain benefit coverage determinations and obtain additional clinical information • Act as a resource for others with less experience • Work independently and collaborate with Medical Directors and non-clinical partners • Adapt to a highly changing environment and a heavy case load You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: • reputed company, unrestricted RN license in the state of residency • 3 years of RN experience including in an inpatient / acute setting • Proven solid clinical background including exemplary proven clinical documentation and critical thinking skills • Proficient computer skills including reputed company Windows, Word, reputed company, Teams, and Outlook • Access to secure high-speed internet at home reputed company cable broadband, DSL, or fiber • Dedicated, distraction-free workspace at home Preferred Qualifications: • Bachelor's degree • Compact RN license OR the ability to obtain one • Experience performing utilization review at an insurance company • Experience providing case management • Proven familiarity with Interqual • Proven excellent verbal and written communication skills • Proven ability to work seamlessly and independently in multiple computer platforms • Proven self-starter with the ability to handle a fast-paced production environment and multiple review types • reputed company working remotely will be required to adhere to reputed company’s Telecommuter Policy. California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, reputed company, Maryland, Rhode reputed company, Washington, Washington, D.C. Residents Only: The hourly range for this role is $28.03 to $54.95 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. reputed company complies with reputed company minimum wage laws as applicable. In addition to your salary, reputed company offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with reputed company, you’ll find a far-reaching choice of benefits and incentives. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of reputed company, historically marginalized groups and those with reputed company incomes. We are committed to mitigating our impact on the environment and enabling and delivering reputed company care that addresses health disparities and improves health outcomes — an reputed company reputed company reflected in our mission. Diversity creates a healthier atmosphere: reputed company is an Equal Employment Opportunity/Affirmative Action employer and reputed company reputed company applicants will receive consideration for employment without regard to race, reputed company, religion, sex, age, national reputed company, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. reputed company is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. Apply Job!