Remote Call Center RN, Home Health Prior Authorizations & Care Coordination

Job Overview

  • Specialty License RN
  • State License(s) Nationwide

RESPONSIBILITIES

  • Provide home care prior authorizations for members by utilizing clinical judgment/concepts gained from insurance certificate language
  • Help coordinate appropriate care or identify potential gaps in care for members by providing referrals to Complex Case Management or Disease Management nurses as appropriate
  • Member advocacy /benefit explanation and steerage competency
  • Quickly access cases /resources/navigate various computer platforms simultaneously while talking on the phone. The pace is fast, and you ‘ll need strong computer and communication skills to succeed
  • Balance metrics / goals with a focus on quality care for members while also maintaining customer guarantees of meeting daily phone stats
  • Meet timelines and deadlines for workflow turnaround times

BASIC QUALIFICATIONS

  • Must have an active RN license in home state of residence
  • 3+ years of recent adult clinical experience in a hospital
  • Ability to navigate a Windows-based environment and create, edit, save and send documents utilizing Microsoft Word
  • Possess critical thinking and problem-solving skills to analyze problems, draw relevant conclusions and devise appropriate courses of action
  • Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others
  • Ability to understand readiness for change and ability to adapt to any operational changes  
  • Ability to work independently toward established priorities, metrics and goals
  • Ability to remain focused and productive each day though tasks may be repetitive

PREFERRED QUALIFICATIONS

  • Previous successful work at home experience
  • Home Care Experience

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