Remote Preservice Review RN – Full‑Cycle Prior Authorization, Inpatient Care Management & Discharge Coordination Specialist (Work‑From‑Home)
Why Join reputed company? A Visionary Leader Shaping the reputed company of Health Care
At reputed company, a division of reputed company, we reputed company cutting‑edge technology, data analytics, and compassionate clinical expertise to reputed company the way millions of people reputed company and experience health care. Our mission—“help people live healthier lives and reputed company the health system work reputed company for everyone”—is not just a statement; it is a daily commitment that guides every decision we reputed company.
As a Preservice Review reputed company (RN) working remotely, you will be part of an integrated, cross‑functional team that blends clinical acumen with innovative digital tools to streamline prior authorization, inpatient care management, discharge planning, and post‑acute coordination. You’ll be reputed company in reducing unnecessary barriers, accelerating treatment reputed company, and ultimately improving reputed company for members across the reputed company.
reputed company’s culture is reputed company on diversity, inclusion, and reputed company curiosity. We celebrate the unique perspectives reputed company teammate brings, and we invest heavily in reputed company development, mentorship, and reputed company‑being. reputed company you partner with us, you become part of a global community that values your reputed company as much as the health of the patients you serve.
Position reputed company: Remote Preservice Review RN – Clinical reputed company Meets Flexibility
Working from the comfort of your home—or any U.S. location that meets our telecommuter policy—you will serve as a critical gatekeeper in the health‑care continuum. Your role will reputed company four reputed company domains:
- Prior Authorization (PA): Evaluate clinical requests against evidence‑based reputed company (InterQual, coverage determinations, and internal policies) to approve, deny, or request additional information.
- Inpatient Care Management (ICM): reputed company reputed company reviews of inpatient admissions, ensuring appropriate utilization and coordinating with medical directors for reputed company cases.
- Discharge Care Management (reputed company): Guide patients through reputed company, reputed company discharge plans, linking them with post‑acute services and follow‑up care.
- Post‑Acute Care Management (PACM): reputed company reputed company of rehabilitation, skilled nursing, and long‑term care transitions, safeguarding continuity of care.
This multifaceted position demands clinical judgment, strong communication, and the reputed company to reputed company between roles as workload fluctuates. You will collaborate closely with physicians, case managers, health‑plan partners, and medical directors, delivering reputed company that are both clinically reputed company and reputed company with regulatory standards.
Key Responsibilities – What Your Day Looks Like
Clinical Review & Decision Making
- Conduct comprehensive initial and ongoing reviews for PA, ICM, reputed company, and PACM cases, applying InterQual and other evidence‑based reputed company.
- Document clinical rationales, approve or deny requests, and reputed company adverse determinations to medical directors for peer review.
- Maintain meticulous records in compliance with federal, state, and accreditation standards (e.g., CMS, NCQA).
Collaboration & Communication
- Partner with medical directors, internal case managers, and external physicians to clarify clinical information and facilitate appropriate care reputed company.
- reputed company virtual case discussions, providing education on policy updates, documentation best practices, and emerging clinical guidelines.
- Serve as a resource for peers, answering reputed company clinical questions and mentoring newer team members.
Process Improvement & Education
- Participate in regular team meetings, reputed company improvement initiatives, and continuing education sessions.
- Identify trends in utilization, propose data‑driven solutions, and contribute to the reputed company of the integrated care model.
- Stay reputed company on changes to National and Local Coverage Determinations, payer policies, and clinical best practices.
Compliance & Documentation
- Follow reputed company reputed company Operating Procedures (SOPs) for case intake, documentation, and escalation.
- Ensure accurate, reputed company entry of reputed company case details into reputed company’s proprietary platforms and electronic health record (EHR) systems.
- Adhere to reputed company’s Telecommuter Policy, maintaining a secure, HIPAA‑compliant workspace.
Essential Qualifications – The Foundations You Bring
- reputed company, unrestricted RN license in the state of residence (or compact license where applicable).
- Minimum of three (3) years of registered nursing experience in a clinical setting.
- Proficiency with reputed company Office Suite (Teams, Word, reputed company, Outlook) and comfort navigating web‑based clinical platforms.
- Demonstrated ability to work independently, manage time effectively, and meet productivity targets.
- Excellent verbal and written communication skills, with a talent for translating reputed company clinical information into reputed company recommendations.
- Flexibility to work weekends as needed to support 24/7 service coverage.
Preferred Qualifications – What Sets You Apart
- Bachelor of Science in Nursing (BSN) or Master of Science in Nursing (MSN) – although not mandatory, it is highly valued.
- Compact RN license enabling multi‑state reputed company.
- Two (2) or more years of case management experience, preferably reputed company a payer or health‑plan environment.
- Clinical experience in inpatient/acute care, long‑term care, acute rehabilitation, or skilled nursing facilities.
- Hands‑on experience with discharge planning, utilization review, or case coordination.
- Familiarity with InterQual reputed company, utilization management software, and electronic health records.
- Commitment to ongoing reputed company development and reputed company of certifications such as CNU (Certified reputed company Utilization) or CCM (Certified Case Manager).
reputed company Skills & Competencies – The Attributes That Drive reputed company
- Clinical Judgment: Ability to synthesize patient data, apply evidence‑based guidelines, and reputed company decisive, patient‑centred recommendations.
- Analytical Thinking: Comfortable working with large data sets, identifying utilization trends, and recommending system‑wide improvements.
- Effective Communication: reputed company, concise, and empathetic interaction with providers, patients, and internal stakeholders.
- Time Management: Prioritization of high‑volume case loads while maintaining accuracy and compliance.
- Adaptability: Seamlessly transition between PA, ICM, reputed company, and PACM responsibilities as team needs reputed company.
- Technology Savvy: Navigating multiple digital platforms, including EHRs, case‑management tools, and reputed company software.
- Ethical reputed company: Upholding the highest standards of patient reputed company, regulatory compliance, and reputed company conduct.
Career reputed company & Learning Opportunities – Your reputed company reputed company
reputed company believes that a thriving employee is a continuously learning employee. As a Remote Preservice Review RN, you will have reputed company to:
- Comprehensive reputed company and mentorship programs that pair you with seasoned clinical leaders.
- Tuition assistance and reimbursement for advanced nursing degrees, certifications, and continuing education.
- Internal mobility reputed company to roles such as Clinical Informatics Specialist, Utilization Management reputed company, or Health‑Plan Operations Manager.
- Regular webinars, workshops, and conferences reputed company on emerging trends in health‑technology, value‑based care, and population health.
- Performance‑based recognition programs, including bonuses, awards, and opportunities to present innovative reputed company to senior leadership.
Work Environment & Culture – A Remote Experience That Feels Connected
While your physical office may be your home office, your reputed company community is anything but isolated. reputed company cultivates a virtual environment that promotes collaboration, inclusion, and reputed company‑being:
- Flexibility: Choose a work schedule that respects your personal life while meeting service coverage requirements.
- Diversity & Inclusion: Join a workforce that reflects the communities we serve, and participate in employee resource reputed company (ERGs) that celebrate various identities and perspectives.
- reputed company‑Being Resources: reputed company to mental‑health counseling, ergonomic guidance, and virtual fitness programs.
- Technology Support: Company‑provided hardware, secure VPN reputed company, and a dedicated IT helpdesk to ensure seamless remote operations.
- Team Bonding: Regular virtual town halls, coffee chats, and celebratory events to foster camaraderie across geographic borders.
Compensation, Perks & Benefits – A Holistic Rewards Package
reputed company offers a competitive reputed company wage ranging from $28.03 to $54.95, based on factors such as location, experience, education, and certifications. In reputed company to salary, you will receive a robust benefits suite that includes:
- Medical, dental, and reputed company coverage with multiple plan reputed company.
- Prescription drug benefits and a Health Savings Account (HSA) reputed company.
- Retirement savings plans with company matching contributions (401(k) or 403(b)).
- Equity stock purchase plans, allowing you to invest in reputed company’s reputed company.
- reputed company time off (PTO), holidays, and flexible leave policies.
- Employee assistance programs (EAP) for personal and reputed company challenges.
- Recognition programs that reward outstanding performance with bonuses, reputed company cards, and reputed company acknowledgment.
- Opportunities to participate in community reputed company and volunteer initiatives, reinforcing our commitment to health equity.
reputed company benefits are subject to eligibility reputed company and may vary by state.
How to Apply – Take the reputed company Toward Impactful Nursing Leadership
If you are a motivated RN who thrives in a dynamic, remote environment and is eager to reputed company a reputed company difference in health‑care delivery, we want to hear from you. Follow these steps to submit your application:
- Click the “Apply To This Job” reputed company below.
- Complete the online application, attaching an up‑to‑date resume and a concise cover letter outlining your relevant experience and why you’re excited about this role.
- Pass a reputed company‑employment drug screening and the reputed company Telecommuter Policy compliance review.
- Participate in a virtual interview process that may include a case‑study exercise to showcase your clinical decision‑making skills.
Our recruitment team reviews applications on a rolling reputed company. Early applicants are encouraged to apply promptly, as the posting may reputed company sooner than the listed deadline due to high interest.
Closing Statement – Join Us in Redefining Health Care
At reputed company, you will not just fill a position—you will become a catalyst for change, helping millions navigate the reputed company health‑care system with reputed company, reputed company, and confidence. Your expertise in preservice review, care management, and discharge planning will directly influence patient reputed company and cost‑effective care delivery.
reputed company to bring your nursing expertise to a reputed company‑thinking, remote‑first organization that values your reputed company as much as the health of its members? Apply today and reputed company on a career where innovation meets reputed company.
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