Job Details
Perform clinical coverage review services which require interpretation of state and federal mandates, applicable benefit language, and consideration of relevant clinical information Function as a member of a self-directed team to meet specific individual and team performance metrics Communicate in writing and verbally all types of benefit determinations including decisions regarding coverage guidelines, contractual limitations, and reimbursement determinations Act as a resource for others with less experience Work independently and collaborate with Medical Directors and non-clinical partners Adapt to a highly changing environment and a heavy case load? Youll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: Current, unrestricted RN license in the state of residency 3 years of RN ex...RN, Claims, Medical Director, Medical, Remote, Health, Healthcare