Match score not available

Nurse Case Manager USRN

Remote: 
Full Remote
Contract: 
Experience: 
Junior (1-2 years)
Work from: 

Offer summary

Qualifications:

Active and Non-Active USRN License, At least 1 Year Clinical Experience.

Key responsabilities:

  • Conduct various medical management reviews
  • Ensure member access to quality healthcare
  • Consult with clinical reviewers for care decisions
Nezda Technologies Inc. logo
Nezda Technologies Inc. Human Resources, Staffing & Recruiting Scaleup https://www.nezdaglobal.com/
201 - 500 Employees
See more Nezda Technologies Inc. offers

Job description

Nezda Technologies Inc. is currently hiring Nurse Case Manager USRN.

πŸ’° Salary: P50,000 to P70,000
πŸ“Œ Permanent Work From Home.

Qualifications:
βœ… Active and Non-Active USRN License.
βœ… With at least 1 Year Clinical or Hospital Experience.
βœ… USRN with RN License.

Job description:
❗️We are in partnership to multiple companies for this position, so you have an option and which company fits you best.
❗️Please take note that this is a direct employment with no bond.

Primary Responsibility:
πŸ‘‰πŸ» Conduct UM pre-service, concurrent, retrospective, out of network, and appropriateness of treatment setting.
πŸ‘‰πŸ» Reviews service requests to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits and contracts.
πŸ‘‰πŸ» Utilize client specific criteria sets (e.g., Milliman or InterQual), applicable client specific medical policy and client clinical guidelines for decision making to either approve or summarize and route to Client’s nursing reviewer and/or Client’s medical staff for review.
πŸ‘‰πŸ» Responsible for conducting medical management review activities which require the review of clinical information against client specific criteria as noted above but excludes denial determinations.
πŸ‘‰πŸ» Ensure member access to medically necessary, quality healthcare in a cost-effective setting according to contract.
πŸ‘‰πŸ» Consult with clinical reviewers and/or U.S. licensed medical directors to ensure medically appropriate, high-quality, cost-effective care throughout the medical management process.

Job Type: Full Time
Job Location: Work from Home

Required profile

Experience

Level of experience: Junior (1-2 years)
Industry :
Human Resources, Staffing & Recruiting
Spoken language(s):
English
Check out the description to know which languages are mandatory.

Other Skills

  • Decision Making

Nurse Practitioner Related jobs