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Preservice Review Nurse RN, MA - Remote Eligible
Conduct pre-service clinical coverage reviews to determine medical necessity for Day Habilitation services.
BostonRemote
Mid-Level
$28.03-$54.95 USD per hour
3 weeks ago
✨ About The Role
- The role involves performing pre-service clinical coverage reviews of Day Habilitation services to determine medical necessity.
- You will assess and interpret prior authorization clinical documentation based on customer needs and requirements.
- The position requires identifying solutions to non-standard prior authorization requests and problems.
- You will be responsible for reviewing and interpreting clinical/medical records submitted from providers.
- Collaboration with internal stakeholders, such as Medical Directors and their staff, is necessary to drive the clinical coverage review process.
⚡ Requirements
- A current, unrestricted nursing license (RN) in the state of Massachusetts is essential for this role.
- Proficiency in MS Office applications, including Word, Excel, PowerPoint, and Teams, is required.
- Familiarity with Salesforce and a solid understanding of MassHealth regulations will be beneficial.
- Strong organizational and time management skills, along with effective communication and math skills, are necessary for success.
- The ability to work independently and solve moderately complex problems is crucial for this position.
Preservice Review Nurse RN, MA - Remote Eligible
BostonRemote
$28.03-$54.95 USD per hour
Registered Nurse
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