Responsibilities
The hours of this role are Mon-Fri, 8am-5pm est.
The Front End Review nurse uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.
Required Qualifications
Active RN license without restrictions
Ability to be licensed in multiple states without restrictions
Prior clinical experience in an acute care, skilled or rehabilitation clinical setting
Excellent computer skills and ability to easily navigate multiple applications
Ability to work independently under general instructions and with a team
Must have the ability to provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10×1 (10mbs download x 1mbs upload) is required
Preferred Qualifications
Prior Utilization review experience
Health Plan experience
Previous Medicare/Medicaid Experience a plus
Scheduled Weekly Hours
40