RN / Medical Reviewer / Remote

InGenesis; Columbia (SC); Remote; USD 60,000 - 90,000; Full time

Job summary

A leading company in healthcare staffing seeks a Remote RN / Medical Reviewer for eligibility assessments and clinical reviews. This role requires a current RN license in South Carolina and involves coordinating care plans based on medical necessity and eligibility. Candidates with clinical experience in various specialties are encouraged to apply.

Qualifications

• Current RN license in South Carolina.
• Requires clinical experience in specialties or utilization review.

Responsibilities

• Perform medical review and authorization processes.
• Ensure accuracy in documenting clinical information.
• Develop and coordinate action plans.

Skills

Utilization Review

Clinical Proficiency

Claims Knowledge

Education

Associates degree in nursing

Job description

RN / Medical Reviewer / Remote

Job Details

Professional Discipline: Registered Nurse

Specialty: Utilization Review

Employment Type: Full Time

City: Columbia

State: SC

Pay Range: [Not specified]

Job Description:

InGenesis is currently seeking a Registered Nurse / RN - Managed Care Coordinator to work remotely for our client located in Columbia, SC. In this role, you will review and evaluate medical or behavioral eligibility regarding benefits and clinical criteria, and assess and monitor medical necessity using your clinical proficiency and claims knowledge.

This is a REMOTE opportunity for candidates residing in South Carolina! Apply today, and we will contact you to answer any questions.

Job Duties

• Perform medical review and authorization processes.
• Ensure coverage for appropriate services within benefit and medical necessity guidelines.
• Assess service needs, develop, and coordinate action plans in cooperation with members, monitor services, and implement plans.
• Evaluate outcomes of plans, eligibility, level of benefits, place of service, length of stay, and medical necessity regarding requested services and benefits.
• Ensure accurate documentation of clinical information to support and determine medical necessity criteria and contract benefits.
• Utilize allocated resources to support review determinations.
• Identify and make referrals to appropriate staff (Medical Director, Case Manager, Preventive Services, Subrogation, Quality of Care Referrals, etc.).
• Participate in data collection and input into systems for clinical information flow and proper claims adjudication.
• Perform other duties as assigned.

Minimum Qualifications

• Current Registered Nurse / RN license in South Carolina.
• Associates degree in nursing or graduation from an accredited nursing school.
• Four years of clinical experience in specialty areas such as oncology, cardiology, neonatology, maternity, rehab, mental health/chemical dependency, or surgery, OR
• Four years of utilization review, case management, or a combination of clinical experience.

EEO Statement:

InGenesis is an equal opportunity employer committed to fostering a diverse, inclusive, and equitable workplace. We comply with all applicable laws and prohibit discrimination or harassment based on race, color, religion, sex, sexual orientation, gender identity, national origin, disability, genetic information, age, veteran status, or other protected characteristics.

We are dedicated to making reasonable accommodations for qualified individuals with disabilities. If you require accommodations during the hiring process, please visit our website at https://www.ingenesis.com/careers/site-accommodations.

Company Statement:

InGenesis is one of the largest staffing firms in the industry and among the largest diversity-owned healthcare staffing firms in North America. We are committed to placing people in positions that preserve and improve lives. Our passionate team is motivated to create innovative solutions and deliver exceptional service to our clients, including nearly half of the Fortune 500 companies across healthcare, life sciences, higher education, and pharma industries.