Case Manager Nurse (RN) - REMOTE
(none selected) US | Fully Remote TELECOMMUTE US
A-Line Staffing Solutions is now hiring several RNs for Remote/Work from Home job openings! The Quality Review RN would be working for a major healthcare organization and has career growth potential. This would be full-time / 40 hours per week.
Compensation & Benefits
- The pay for this position is $36.20 per hour, paid weekly
- Benefits are available to full-time employees after 90 days of employment and include health, optical, dental, life, and short-term disability insurance
- A 401(k) with a company match is available for full-time employees with 1 year of service on our eligibility dates
- Reviews documentation and evaluates the necessity of provider requests, but applying national and state based criterion, thus conducting Medical Necessity Review. Staff may be required to contact the providers of record, vendors, or internal Aetna departments to obtain additional information.
- Accurately applies review requirements to assure case is reviewed by a practitioner with clinical expertise for the issue at hand.
- Commands a comprehensive knowledge of complex delegation arrangements, contracts ,clinical criteria, benefit plan structure, regulatory requirements, company policy and other processes which are required to support the review of the clinical documentation/information.
- Pro-actively and consistently applies the regulatory and accreditation standards to assure that activities are reviewed and processed within guidelines.
- Condenses complex information into a clear and precise clinical picture while working independently
- RN License (any state in USA), compact status preferred
- Managed Cared experience preferred
- 3 - 5 years of nursing experience
case manager, rn, registered nurse, utilization management, prior authorizations, remote, work from home, WFH, Remote Nurse