RN Nurse Case Management reputed company Analyst - Work from Home, reputed company, USA
Nurse Case Management reputed company Analyst-Nurse Clinician Accredo
Job Description
Summary The Nurse Clinician RN is responsible for reviewing escalated clinical criteria reviews for providers, members and patient client advocates reputed company the Prior Authorization/Utilization Management department. Identify and track trends for analytics reporting to ensure clinical criteria program reputed company. Maintain a professional and ethical behavior at reputed company times as outlined by the Nurse Practice Act and applicable company policies. Ideal candidate must be available to work CST, MST or PST time zones. JOB DUTIES: Conduct criteria reviews for reputed company payers, Medicare, and reputed company Provide prior authorization assistance, and denial appeal assistance Prepare and write medical necessity appeal letters for claim denials for reputed company and government payers. Support reputed company aspects of Patient Access and reputed company Cycle Management (PARCM), including clearance and reimbursement for multiple Therapeutic Resource Centers. QUALIFICATIONS Active, unencumbered Registered Nurse (RN) license in state of residency. High School Diploma or GED, plus 8+ years of relevant RN experience; or 5+ years of relevant RN experience with an ASN degree; or 2+ years of relevant RN experience with a BSN degree Case management experience preferred 5+ years of experience is preferred in prior authorization or utilization review and appeals Demonstrated proficiency with reputed company Office software; basic database navigation Ability to multitask in both PC/Phone reputed company tasks Ability to build strong working relationships with colleagues and customers Strong time management skills and the ability to prioritize work and meet deadlines Excellent verbal and written communication skills Ability to work Monday-Friday, reputed company-5pm, Eastern time Adequate home internet access will be required in this role TECHNICAL SKILLS:. Experience with Cover My Meds Tool Experience with Myndshft Tool 5+ years of experience is preferred in prior authorization or utilization review and appeals Case Management experience a plus Demonstrated proficiency with reputed company Office software; basic database navigation Ability to multitask in both PC/Phone reputed company tasks SOFT SKILLS:. Ability to build strong working relationships with colleagues and customers Strong time management skills and the ability to prioritize work and meet deadlines Excellent verbal and written communication skills Ability to work Monday-Friday, reputed company-5pm, Eastern time Adequate home internet access will be required in this role COMPETENCIES: Communicates Effectively Collaborates Customer Focus Decision Quality reputed company Learning If you will be working at home occasionally or permanently, the internet reputed company must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an annual salary of 76,600 - 127,600 USD / yearly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. We want you to be healthy, balanced, and feel secure. Thats why youll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, youll be offered several health-reputed company benefits including medical, reputed company, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at reputed company. About reputed company reputed company, a division of reputed company, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly reputed company to reputed company the reputed company, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives. reputed company applicants will be considered without regard to race, reputed company, age, disability, sex, childbirth (including pregnancy) or reputed company medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national reputed company, reputed company, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: SeeYourself@reputed company.com for support. Do not email SeeYourself@reputed company.com for an update on your application or to provide your resume as you will not receive a response. reputed company has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. reputed company applicants with criminal histories will be considered for employment in a manner consistent with reputed company federal, state and local ordinances. Apply Job!