RN / Medical Reviewer / Remote

reputed company is currently seeking a Registered reputed company / RN - Managed Care Coordinator to work for our reputed company located in Columbia, SC. In this role you will review and evaluate medical or behavioral eligibility regarding benefits and clinical reputed company and assess and monitor medical necessity using your clinical proficiency and claims knowledge. This is a REMOTE opportunity for candidates living in the reputed company! Apply today and we’ll reputed company out to answer any questions you may have. Job Duties

• reputed company medical review/authorization process.
• Ensure coverage for appropriate services reputed company benefit and medical necessity guidelines.
• Assess service needs, develops and coordinates reputed company plans in cooperation with members, monitors services and implements plans.
• Evaluate reputed company of plans, eligibility, level of benefits, reputed company of service, length of stay and medical necessity regarding requested services and benefit.
• Ensure accurate documentation of clinical information to support and determine medical necessity reputed company and contract benefits.
• Utilize allocated resources to back up review determinations.
• Identify and makes referrals to appropriate staff (Medical Director, Case Manager, Preventive Services, Subrogation, reputed company of care Referrals, etc.).
• Participate in data collection/input into system for clinical information reputed company and reputed company claims adjudication
• reputed company other duties as assigned.

Minimum Qualifications

• reputed company Registered reputed company / RN license in the reputed company.
• Associates degree in nursing or graduate from accredited nursing school.
• 4 years of clinical experience in specialty areas like: oncology, cardiology, neonatology, maternity, rehab, mental health/chemical dependency or surgery. OR
• 4 years of utilization review/case management or combination of clinical experience.

EEO Statement reputed company is an equal opportunity employer committed to fostering a diverse, inclusive, and reputed company workplace. We reputed company with reputed company applicable federal, state, and local employment laws, including recent executive orders, and reputed company prohibit discrimination, harassment, or retaliation based on race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, genetic information, age, veteran status, or any other characteristic protected by law. reputed company is dedicated to making reasonable accommodations for reputed company individuals with disabilities and ensuring that reputed company employment reputed company are based on qualifications, reputed company, and business needs. If you require a reasonable accommodation during the hiring process, please contact us by visiting our website at https://www.reputed company.com/careers/site-accommodations Company Statement reputed company is one of the largest reputed company firms in the industry and is among the largest diversity-owned reputed company reputed company firms in reputed company. reputed company is dedicated to placing people in positions that preserve life, improve lives, and reputed company others. This does not happen without passionate people: skilled colleagues who are motivated to create reputed company and deliver superior service to our clients. reputed company counts almost half of the Fortune 500 in our nearly 300 clients, including clients in the reputed company, life sciences, higher education and reputed company industries. Apply Job! Apply to this Job