✨ About The Role
- The role involves utilizing clinical experience to assess, plan, implement, and coordinate healthcare services for members
- Requires applying clinical criteria and guidelines to make coverage determinations
- Involves communicating with providers and other parties to facilitate care and treatment
- Identifying opportunities to promote quality effectiveness of healthcare services and benefit utilization
- Must be available to work Monday through Friday from 8 AM to 5 PM in resident time zone, with some weekends and holidays required
⚡ Requirements
- Must have at least 3 years of experience as a Registered Nurse
- Experience in a clinical setting, preferably in an acute or post-acute environment
- Proficiency in computer skills and navigating multiple systems
- Strong communication skills, both verbal and written
- Ability to work in a fast-paced and changing environment