Utilization Review Nurse/ Registered Nurse (100% REMOTE)
Position Title: Registered Nurse II (100% REMOTE) Assignment Duration: 3 Months Work Schedule: M-F, 9-5:30pm EST with 30 min unpaid lunch Work Arrangement: Virtual Position Summary: Responsible for clinical criteria prior authorization setup to meet client needs and ensure operational efficiency. Key Responsibilities:
- No direct patient care. This is a virtual position.
- Responsible for clinical criteria prior authorization setup, which takes client clinical policy requirements and creates the prior authorization request sent to prescribers. This could include questions such as (but not limited to) is the patient 18, does this patient have , has the patient tried and failed these alternative medications etc.
- The creation of questions and answers along with other additional configuration will allow prescribers to answer questions leading to either an approval or denial.
- Clinicians are also responsible for creating and coding denial rationales sent to prescribers and patients.
- The system leveraged for this coding is a web-based platform proprietary to ESI, and selected contractor will be trained on how to leverage this platform.
- Configuration support will be for both pharmacy and medical criteria and will require good creative problem solving skills to ensure appropriate setup to meet client needs and maximum operation efficiency.
- Consultative support in explaining setup and system requirements might be needed if discussing criteria setup with other internal ESI business partners.
Qualification & Experience:
- Requires RN license.
- Current RN Licensure in good standing as required by the state in which work is performed.
- Communication, Microsoft Office, Organization, Self-Driven, Collaboration.
- Demonstrates 'Team Player' and collaborative skills within internal and external teams.
- Takes risks by thinking strategically about problems and challenges within their domain.
- Communicates effectively within peer group and subordinate groups.
- Holds oneself accountable for designated client relationships and the delivery of requests associated to service.
- Capable of & develops robust operational controls to maximize service levels.
- Able to identify the needs of clinical system or process changes to help enhance service levels.
- Ability to comprehend and articulate the importance of assigned responsibilities and controls.
- Able to mitigate concerns of business partners within direct scope of responsibility.
- Able to clearly communicate directly with clients when providing consultative services.
Certifications & Licenses:
- RN
- RN license
- Registered Nurse
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At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws. This position's starting pay is: $30.00/hr. Remote About the Company: Spectraforce Technologies Inc Spectraforce is a leading global services firm that provides a portfolio of Consulting, Staffing and Outsourcing services & solutions to a broad range of clients and industries worldwide. We are headquartered in Raleigh, NC, USA and have offshore global delivery centers at Pune, Chandigarh, and Hyderabad, India. At Spectraforce we have a Philosophy - a Philosophy that excellence is derived through dedicated, focused and innovative work. We also believe that knowledge comes through sharing and growth comes to every organization where people use knowledge in team work. A progressive culture and a world of possibilities is what you see with us. Company Size: 500 to 999 employees Industry: Computer/IT Services Founded: 2004 Website: http://www.spectraforce.com Apply tot his job Apply To this Job