Employer Industry: Managed Care and Health Insurance

Why Consider this Job Opportunity:
- Fully remote position with flexible working hours
- Comprehensive benefits package including health, dental, and vision coverage
- 401k retirement savings plan with company match
- Paid Time Off (PTO) and education assistance
- Opportunity to work in a diverse and inclusive environment that promotes career development
- Chance to make a positive impact on members’ health and well-being

What to Expect (Job Responsibilities):
- Perform medical or behavioral review/authorization processes to ensure coverage for appropriate services
- Evaluate outcomes of plans, eligibility, and medical necessity regarding requested services
- Provide patient education regarding healthcare delivery systems and benefits
- Maintain knowledge of contracts and network status of service providers
- Communicate effectively with healthcare providers and members regarding requested services

What is Required (Qualifications):
- Required Education: Associate's degree in a job-related field
- Minimum of 2 years of clinical experience
- Active, unrestricted RN licensure or LMSW from the United States and in the state of hire
- Strong organizational, customer service, and communication skills
- Proficiency in Microsoft Office and ability to handle confidential information

How to Stand Out (Preferred Qualifications):
- Bachelor's degree in Nursing
- Experience in healthcare program management or clinical specialty areas such as oncology or mental health
- Willingness to learn new systems and software
- Knowledge of contract language and claims/coding analysis
- Familiarity with spreadsheet and database software

#ManagedCare #HealthcareJobs #RemoteWork #CareerDevelopment #InclusiveWorkplace

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