FLORIDA – Remote Medicaid Utilization Review RN

Job Overview

  • Specialty License RN
  • State License(s) FL

ApprioHealth is seeking a Medicaid Utilization Reviewer. The Medicaid Utilization Reviewer will serve as a resource to help facilitate the organization’s mission, core values, and vision. They will assist in submitting necessary clinical information to EQHealth Solutions to obtain an authorization, continuous assessment of review disposition, and maintaining accurate records in organization and partner systems.

Roles and Responsibilities

  • Utilize eligibility systems or other online resources to determine if customer has existing insurance coverage
  • Review medical records in partner systems to ensure all relevant clinical information is present to submit authorization review
  • Submit all necessary clinical information to EQHealth Solutions to obtain authorization
  • Continuous assessment of submitted review to ensure timely processing
  • Maintain accurate records in database of actions taken for all customer accounts
  • Update partner systems as determined by process flow
  • Meet individual goals as determined by Team Leads/Managers/Directors to assist in meeting organization revenue targets
  • Provide other duties as necessary which may be assigned by Team Leads/Managers
  • Demonstrate ApprioHealth’s mission, core values and vision to employees and partners

Qualifications and Education Requirements

  • Bachelor’s Degree in an Accredited Nursing Program
  • Current Registered Nurse (RN) license in the State of Florida
  • 3+ years of RN experience in acute care setting preferred
  • Knowledge of standard Medicaid authorization practices and EQHealth Solutions
  • Basic understanding of technology, such as phone systems, computers, Microsoft software applications such as Word, Excel, Outlook, etc.
  • Demonstrated maturity and capacity to navigate a complex structure and respond to shifting and fluid priorities
  • Ability to build consensus and relationships among customers, other staff, management, and partner
  • Ability to remain calm and courteous under pressure and navigate tense situations
  • Excellent verbal and written communication skills
  • Excellent problem solving and customer service skills

Additional Information

  • This position is fully remote, the employee will work from home

Job Type: Full-time

Benefits:

  • Dental Insurance
  • Health Insurance
  • Life Insurance
  • Paid Time Off
  • Vision Insurance

Schedule:

  • 8 Hour Shift
  • Day shift
  • Monday to Friday

COVID-19 considerations:
On boarding will take place in our office for 1 day. The room is sanitized and there will only be the HR representative and 2 others present. Masks are required to be worn during the day.

Experience:

  • standard Medicaid authorization practices: 1 year (Preferred)
  • RN experience in an acute care setting: 3 years (Required)

Education:

  • Bachelor’s (Required)

License:

  • Florida Registered Nurse (RN) license (Required)

Work Location:

  • Fully Remote

Patient Type:

  • Pediatric
  • Adults
  • Geriatric
  • Family
  • Women’s Health
  • Neonatal

Relocation Assistance Provided:

  • No

Company’s website:

  • www.appriohealth.com

Benefit Conditions:

  • Only full-time employees eligible

Work Remotely:

  • Yes