Industry: Outsourcing/Offshoring Multinational professional services company Graveyard Shift Full-time Employment Voice-based operations Temporary WFH Setup for 2021 Competitive Salary Package HMO Coverage Remote/Virtual Recruitment Process
Job function: Health Care Provider
Responsible to collaborate with healthcare providers and members to promote quality member outcomes, to optimize member benefits, and to promote effective use of resources. Responsible in collaborating with healthcare providers and members to promote quality member outcomes, to optimize members’ benefits, and to promote effective use of resources Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards, accurately interpreting benefits and managed care products, and may steer members to appropriate providers, programs or community resources Work with medical directors in interpreting appropriateness of care
BS Nursing (BSN) Degree Active US State License holder A minimum of three (3) months’ of prior working experience as a Registered Nurse in a clinical setting required:Three months is equivalent to 480 hours of working experience as an RNWorking experience as a Registered Nurse means holding an active RN license and providing direct patient careClinical setting includes inpatient hospital or clinic
The interview process will be remotely. This position is open to all US Registered Nurse only.