✨ About The Role
- The role involves utilizing clinical experience to assess, plan, implement, coordinate, monitor, and evaluate healthcare services for members
- Requires applying clinical criteria, guidelines, policies, and procedures to make coverage determinations along the continuum of care
- Involves communicating with providers and other parties to facilitate care and treatment for members
- Identifying opportunities to promote quality effectiveness of healthcare services and benefit utilization
- Collaborating with internal and external constituents in the coordination and administration of the utilization/benefit management function
âš¡ Requirements
- Experienced Registered Nurse with a minimum of 3 years of clinical experience in an acute or post-acute setting
- Must possess an active and unrestricted RN licensure in the state of residence
- Ability to work Monday through Friday from 8 AM to 5 PM in the time zone of residence
- Proficient in computer skills, multitasking, and adapting to a fast-paced environment
- Effective communication skills, both verbal and written, are essential for this role