Registered Nurse II

Immediate need for a talented Registered Nurse II. This is a 06 Months Contract opportunity with long-term potential and is located in U.S.(Remote). Please review the job description below and contact me ASAP if you are interested.

Job ID:25-88831

Pay Range: $32 - $35.98/hour.  Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).
 
Key Responsibilities:

• 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 Client, and selected contractor will be trained on how to leverage this platform.
• Additionally, the individuals should have strong skills with Microsoft office, particularly excel.

Key Requirements and Technology Experience:

• Skills-“Registered Nurse”, “Prior Authorization experience”, “RN License”, “Pharmacy and Medical Criteria”
• Licensed RN
• Good communication
• Communication, MicroSoft Office, Organization, Self-Driven, Collaboration Qualifications:
• 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
• 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 Client business partners.
• An individual with strong and effective communication skills is highly desired.

Our client is a leading  healthcare Insurance Industry and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.
 
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