Pre-Service Review Nurse RN-Remote in PST or MST-California RN License
About the positionResponsibilities• Function is responsible for utilization management which includes Prior Authorization Review of skilled nursing facility, acute inpatient rehabilitation and long-term acute care hospital. • Determines medical appropriateness of level of care following evaluation of medical guidelines and benefit determination. • Generally, work is self-directed and not prescribed. • Works with less structured, more complex issues. • Identify solutions to non-standard requests and problems.• Translate concepts into practice. • Act as a resource for others; provide explanations and information on difficult issues. Requirements• Unrestricted RN License in the state of California and in your state of residence (if primary residence is not in California). • 3+ years of Clinical Nursing experience. • 1+ years of Utilization Review and/or Prior Authorization experience within a Managed Care environment. • Proven basic computer skills with MS Outlook, Word and Excel. • Primary residence in Pacific or Mountain Time Zone.• Ability to work Mon-Fri 8-5 PST or MST and at least 2 weekend days per month. Nice-to-haves• Multi-Specialty experience. • Experience in a skilled nursing facility, LTAC or inpatient rehabilitation facility. • Multiple EMR experience including Epic, Cerner, TMC, Meditech or Care Advance. • Knowledge of Milliman Criteria (MCG). • Knowledge of Medicare Criteria. Benefits• Comprehensive benefits package. • Incentive and recognition programs. • Equity stock purchase. • 401k contribution. Apply tot his job