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Telephonic Registered Nurse Clinical Reviewer - EviCore - Remote
520 eviCore healthcare MSI, LLC
This is a full-time, remote Telephonic Registered Nurse Clinical Reviewer role responsible for clinical certification activities, utilization management, and evaluating authorization requests. The position requires a Monday through Friday evening shift with initial day shift training.
Job Description
Role Overview
- Full-time remote Registered Nurse Clinical Reviewer position.
- Required shift: Monday through Friday, 12:30 PM - 9:00 PM EST.
- Initial 7 weeks of employment will be day shift for training.
Key Responsibilities
- Evaluate telephone, fax, or web requests for clinical service authorization against established protocols.
- Review clinical information and issue determinations or refer to physician review as needed.
- Maintain departmental standards related to productivity and patient confidentiality (HIPAA).
- Serve as a resource for members and make outbound calls as required.
- Handle provider/member complaints and appeals.
Requirements
- Associate's Degree in Nursing required.
- Current, unrestricted RN license in the state of primary residence.
- Minimum of 1 year of acute care, managed care, ER, or ICU experience, or 2 years of clinical utilization management experience.
- High-speed internet connection (minimum 10Mbps download/5Mbps upload via cable broadband or fiber optic).
Requirements & Skills
Specialty
Utilization Management
Education
Associate
Experience
1+ year
Licenses
RN
Skills
Clinical ReviewUtilization ManagementTelephonic NursingHIPAA ComplianceCustomer ServiceProblem SolvingCase Review