Back to Jobs

Preservice Review Nurse RN - Remote MUST BE PST or MST

Remote, USA Full-time Posted 2025-04-26

About the position

The position involves performing clinical coverage review services to ensure members receive appropriate health services. The role requires communication with healthcare providers and members to explain benefit coverage determinations and gather clinical information. It offers the flexibility to work remotely and emphasizes the importance of autonomy and responsibility in decision-making that impacts members' health outcomes.

Responsibilities
• Perform clinical coverage review services, interpreting state and federal mandates and applicable benefit language.
,
• Communicate benefit determinations, including coverage guidelines and reimbursement decisions.
,
• Speak to healthcare providers and members to explain benefit coverage determinations and obtain additional clinical information.
,
• Act as a resource for less experienced colleagues.

Requirements
• Current unrestricted RN license in the state of residency.
,
• 3+ years of RN experience, including experience in an inpatient/acute setting.

Nice-to-haves
• Bachelor's Degree.
,
• Background involving utilization review for an insurance company or experience in case management.
,
• Familiarity with Milliman Care Guidelines.
,
• Proven ability to use diverse knowledge and experience to improve healthcare for patients.

Benefits
• Comprehensive benefits package.
,
• Incentive and recognition programs.
,
• Equity stock purchase.
,
• 401k contribution.

Apply Job!

 

Similar Jobs

Clinical Data Abstractor - Cardiology - Chest Pain MI - Part-Time

Remote, USA Full-time

RN/LPN Need | 1:1 Position W/ Bus Riding | ASAP Hire

Remote, USA Full-time

Axis Bank Hiring For Human Resources: Graphic Designer F at Remote

Remote, USA Full-time

Remote For State Farm Agent Office. State Farm Experience Required Sales/service

Remote, USA Full-time

A / P Generalist – Legacy Manufacturing (job id : 1675061028)

Remote, USA Full-time

Medical Billing Intake Specialist (Monday- Friday 8am-5pm PST) #4051 - Remote

Remote, USA Full-time

School Licensed Vocational Nurse (LVN) - Full Time in Sacramento, CA

Remote, USA Full-time

Zippy Guide Assistant (Remote - Phoenix, AZ or Dallas, TX preferred)

Remote, USA Full-time

Corporate Accounting & Systems Analyst ( Can be 100% remote )

Remote, USA Full-time

Financial Planning Analyst - Remote (Must Have SAP & Hyperion Exp)

Remote, USA Full-time

[Entry Level/No Experience] American Express Part-Time Customer Support Jobs

Remote, USA Full-time

Coca Cola – Retail Activation Specialist – New Brunswick, NJ

Remote, USA Full-time

Urgently Hiring: Immediately Need Humanities and Social Sciences

Remote, USA Full-time

Immediate Hiring: Virtual Therapist (Full-Time)

Remote, USA Full-time

Join Today: Immediately Need Substitute Teacher Training

Remote, USA Full-time

Coordinator-BGCO Customer Service

Remote, USA Full-time

Mgr Sales

Remote, USA Full-time

Paid immediate start

Remote, USA Full-time

Grocery shopper and delivery driver | Dallas, TX

Remote, USA Full-time

Immediate Hiring: Require Lecturer (master level) or Assistant

Remote, USA Full-time