Hybrid RN: Pre-Cert & Care Navigation Specialist

Quantum Health, Inc.; Dublin (OH); Híbrido; USD 52.000 - 103.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Health coverage

401(k) plan with employer match

PTO and holidays

Descripción de la vacante

Quantum Health, Inc. is seeking a Pre-Certification Nurse for our Dublin, OH campus with hybrid flexibility. The role involves reviewing requests for inpatient services, interfacing with providers, and ensuring timely processing of clinical documentation to support members.

You will coordinate health management services, translate complex clinical concepts for members, and support non-clinical staff during business hours. A valid clinical license and hospital experience are required.

Formación

• Active, unrestricted professional license in a clinical discipline (RN/LPN or equivalent).
• License in good standing; MSL where applicable; obtain state licenses within 90 days of hire.

Responsabilidades

• Review inpatient medical service requests against clinical criteria.
• Coordinate health management services and provide information to patients and providers.
• Facilitate discharge during pre-service review and coordinate with clinical teams.
• Redirect out-of-network requests to in-network providers when possible.
• Research procedures and inform Chief Medical/Physician Peer Reviewer.
• Identify high-risk or high-cost cases and advise Case Management.
• Coordinate with providers and facilities regarding outcomes.
• Translate clinical messages to members with empathy.
• Provide clinical support during business hours and supervise non-clinical staff.

Conocimientos

Administrative skills

Verbal and written communication

MS Office proficiency

Educación

Active professional license (RN/LPN/other)

Herramientas

Microsoft Office

Teams

Zoom

Descripción del empleo

Quantum Health, Inc. is seeking a Pre-Certification Nurse for our Dublin, OH campus with hybrid flexibility. The role involves reviewing requests for inpatient services, interfacing with providers, and ensuring timely processing of clinical documentation to support members.

You will coordinate health management services, translate complex clinical concepts for members, and support non-clinical staff during business hours. A valid clinical license and hospital experience are required.