This job has expired.
Location: REMOTE
Salary: $31.00 USD Hourly - $32.00 USD Hourly
Description: Judge Healthcare is seeking RN's for a REMOTE Clinical Review Manager position for one of our biggest clients!
Type: Contract 6+ months with possible conversation
Hours: Mon- Fri Business hours
Location: REMOTE!
Pay: $32/hr
Responsibilities:
- Conduct comprehensive clinical reviews of requested services using established clinical criteria received through various channels.
- Initiate referrals to ensure efficient coordination of care.
- Consult with the Medical Director when necessary, following company policy.
- Assist non-clinical staff in performing administrative reviews.
- Handle comprehensive provider and member appeals, denial interpretation for letters, retrospective claim reviews, special review requests, and utilization management (UM) pre-certifications and appeals. Utilize medical appropriateness criteria, clinical judgment, and contractual eligibility.
- Be available for weekend work as needed.
- Successfully complete the Windows navigation test.
Qualifications:
- Registered Nurse (RN) with an active license in the state of Tennessee or a license in the state of residence if participating in the Nurse Licensure Compact Law.
- Minimum of 3 years of clinical experience.
- Proficiency in Microsoft Office applications (Outlook, Word, Excel, and PowerPoint).
- Familiarity with URAC, NCQA, and CMS accreditations.
- Ability to work independently and creatively.
- Excellent oral and written communication skills.
Are you interested or know someone that might be? Reach out to Britney Bishop at 214-281-5953 or email an updated resume to bbishop@judge.com for immediate consideration!
Contact: bbishop@judge.com
This job and many more are available through The Judge Group. Find us on the web at www.judge.com
This job has expired.
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