Job Description
RN- Utilization Review Nurse
LTSS/DME
*Full Time 100% Remote Opportunity*
COME WORK FOR THE LEADING, LOCAL MANAGED CARE COMPANY - VILLAGECARE!
VillageCare is looking for a self-motivated and passionate RN as Utilization Review Nurse for a Full-Time position. This is an exciting and dynamic position from the comfort of your own home as you will be responsible for the assessment of member needs and identification of solutions that promote high quality and cost effective health care services. Some of your daily activities will include:
We would like to speak to those who have a current unrestricted NYS RN license to practice professional nursing, URAC preferred. Seeking those who bring a BSN (advanced degree preferred), along with 2+ years of utilization review experience at a Managed Care Organization or Health Plan required. Experience in MLTC - understanding of authorizing PCA, DME, PERS, and SADC. Working knowledge of Medicaid and/or Medicare regulations as well as coverage guidelines and benefit limitations. The ability to apply Interqual/ Milliman Care Guidelines and other applicable, evidenced-based clinical guidelines will be vital to this role.
There are many benefits to working for VillageCare. If you are someone who likes being part of a team, enjoys a highly competitive benefits package from world leading carriers and competitive compensation, than we would love to speak with you!
VillageCare offers a wide range of at-home and community-based services, as well as managed long-term care options that seek to match each individual's needs to help them attain and maintain the greatest level of independent living possible. We are committed to superior outcomes in quality health care.
VillageCare is an Equal Opportunity Employer.
Job Posted by ApplicantPro...addition to limited travel to interesting locations while on site for events. A qualified candidate for the position of Motion Graphics Designer will have 3-5+ years of experience in graphic design and animation in an ad agency or production studio environment. Our ideal...
...of the Analyst will include, but are not limited to: Performing AML alert/case reviews, seeking to mitigate risks associated to financial... ...Knowledge of applicable laws, regulations, and guidelines (e.g., BSA, OFAC, FinCEN guidance). Experience working with manual and...
...Job Description Job Description Job Description We have an enterprise tech client who is in need of a recruiting coordinator. This is a six-month contract with the potential to get extended or turn into full-time. The preferred candidate will live in an East...
...healthcare system for physicians, patients, and the clinical community. At Altais, were building breakthrough clinical support tools... ...Visits in the Bay Area. About Your Work The Community Health Advocate will assist members to locate and connect to needed services...
...Position Overview: Our Billing Specialists are responsible for answering patient inquiries, reviewing outstanding or denied insurance... ...and insurance industry contract policies/ procedures and medical terminology Participate in professional development efforts...