Nurse Case Manager USRN

Nezda Global; Deutschland; Remote; EUR 50.000 - 70.000; Vollzeit

Zusammenfassung

A healthcare staffing agency is seeking a Nurse Case Manager with an active USRN license to conduct Utilization Management reviews. This position offers permanent remote work, requiring at least one year of clinical or hospital experience. You will ensure compliance with medical policies, assess treatment appropriateness, and consult with medical directors for optimal patient care.

Qualifikationen

• Minimum 1 year of clinical or hospital experience required.
• Active USRN license is necessary.

Aufgaben

• Conduct Utilization Management (UM) reviews and assess treatment appropriateness.
• Ensure service request compliance with medical policies and eligibility.
• Consult with U.S.-licensed medical directors for high-quality care.

Kenntnisse

Active and Non-Active USRN License

Clinical Experience

Reviewing Clinical Information

Jobbeschreibung

Nezda Technologies Inc. is currently hiring a Nurse Case Manager (USRN).

Salary: P50,000 to P70,000
Permanent Work From Home.

Qualifications:
Active and Non-Active USRN License.
At least 1 Year of Clinical or Hospital Experience.
USRN with RN License.

Job Description:
We are partnered with multiple companies for this position, giving you options to choose the company that best fits you.
Please note that this is a direct employment opportunity with no bond.

Primary Responsibilities:
Conduct Utilization Management (UM) pre-service, concurrent, retrospective, out-of-network reviews, and assess the appropriateness of treatment settings.
Review service requests to ensure compliance with applicable criteria, medical policies, member eligibility, benefits, and contracts.
Utilize client-specific criteria sets (e.g., Milliman or InterQual), applicable client-specific medical policies, and clinical guidelines for decision-making to approve or route cases for further review.
Conduct medical management review activities, including reviewing clinical information against client-specific criteria, excluding denial determinations.
Ensure members have access to medically necessary, quality healthcare in a cost-effective setting, in accordance with the contract.
Consult with clinical reviewers and/or U.S.-licensed medical directors to ensure the delivery of medically appropriate, high-quality, and cost-effective care throughout the medical management process.