Remote RN Medical Reviewer II – Appeals & Utilization

CGS Administrators LLC; Nashville (TN); A distancia; USD 65.000 - 90.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Health insurance

401k retirement savings plan

Paid Time Off (PTO)

Descripción de la vacante

CGS Administrators LLC seeks a qualified RN reviewer to perform medical reviews based on clinical information and established guidelines. The role documents decisions and supports medical claims and utilization practices.

The position is full-time and remote with a mandatory 8-hour shift, Monday–Friday. Hybrid options exist for candidates near Nashville, TN or Columbia, SC, involving three days onsite and two days remote.

Formación

• Associate's degree or equivalent.Graduate of Accredited School of Nursing.
• Active RN licensure in state hired or compact multistate RN license as defined by NLC.
• 2 years clinical experience.
• Ability to work independently and make sound decisions.

Responsabilidades

• Documents the basis of the appeal or retrospective review in an accurate and timely manner.
• Performs thorough research of the substance of service appeals based on clinical documentation and policies.
• Performs appeal and retrospective reviews applying relevant policies to clinical information.
• Performs special projects identifying quality of care issues.

Conocimientos

Word processing

Independent work

Decision making

Customer service

Oral and written communication

Analytical thinking

Confidential information handling

Educación

Associate's degree

Graduate of Accredited School of Nursing

Herramientas

Microsoft Office

Descripción del empleo

CGS Administrators LLC seeks a qualified RN reviewer to perform medical reviews based on clinical information and established guidelines. The role documents decisions and supports medical claims and utilization practices.

The position is full-time and remote with a mandatory 8-hour shift, Monday–Friday. Hybrid options exist for candidates near Nashville, TN or Columbia, SC, involving three days onsite and two days remote.