Employer Industry: Healthcare Insurance

Why consider this job opportunity:
- Fully remote position with a flexible schedule
- Comprehensive benefits package including subsidized health plans, dental and vision coverage
- 401k retirement savings plan with company match
- Paid Time Off (PTO) and education assistance
- Opportunity for career advancement and growth within the organization
- Supportive and inclusive work environment fostering diversity

What to Expect (Job Responsibilities):
- Perform medical or behavioral review/authorization processes to ensure coverage for appropriate services
- Utilize allocated resources to support review determinations and make referrals to appropriate staff
- Provide patient education regarding health care delivery systems and benefit plans
- Maintain current knowledge of contracts and network status of service providers
- Communicate effectively with healthcare providers and members regarding requested services

What is Required (Qualifications):
- Associate's degree in a job-related field, or graduate of an accredited school of nursing, or 2 years of job-related work experience
- Minimum of 2 years of clinical experience
- Active, unrestricted RN licensure or LMSW licensure from the United States
- Proficiency in Microsoft Office and word processing software
- Strong oral and written communication skills, with the ability to handle confidential information

How to Stand Out (Preferred Qualifications):
- Bachelor's degree in Nursing
- Experience in healthcare program management, utilization review, or clinical experience in specialty areas such as oncology or cardiology
- Willingness to learn new systems and software
- Knowledge of contract language and application
- Understanding of claims/coding analysis and requirements

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