Remote Prior Authorization Nurse Reviewer (RN) – Alaska

Job Overview

  • Clinical License RN
  • State(s) AK

Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at HMS, a Gainwell Company carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work flexibility, learning, and career development. You’ll add to your technical credentials and certifications while enjoying a generous, flexible vacation policy and educational assistance. We also have comprehensive leadership and technical development academies to help build your skills and capabilities.

 

Summary

The Prior Authorization Nurse Reviewer will perform prior authorization reviews of admissions, procedures, services, and supplies to determine medical necessity, appropriateness, and reasonableness of care while maintaining production goals and quality standards.

Your role in our mission

  • Complete medical necessity and level of care reviews for requested services using the appropriate clinical criteria.
  • Document decisions and rationale while maintaining pertinent clinical information in various medical management systems.
  • Assists management with training new Utilization Review Nurses to include daily monitoring, mentoring, feedback, and education.
  • Maintains current knowledge of clinical criteria guidelines and successfully completes required CEUs to maintain RN license.
  • Responsible for attending training and scheduled meetings to enhance skills and working knowledge of clinical policies, procedures, rules, and regulations.
  • Actively cross-trains to perform multiple review types to provide a flexible workforce to meet client needs.

What we’re looking for

  • Active and unrestricted United States nursing (RN) license required
  • 5+ years clinical or in facility experience
  • 1+ year of utilization review experience
  • Must be an Alaska resident.
  • Experience in InterQual or Milliman criteria is helpful

What you should expect in this role

  • This is a full-time permanent regular salaried (W-2) employee position.
  • Upward career advancement is possible and encouraged.
  • Health (medical, dental, vision) and paid time off benefits start on day 1 of employment.
  • Company match 401K and other benefits available within months of starting.
  • Company provided computer for work.
  • Our schedule is working from home on Monday through Friday 8 AM to 5 PM daily.
  • For all hybrid and remote positions employees’ Broadband Internet connections, should have a minimum speed of 24MBS download and 8 MBS upload.  Greater speeds will of course provide better performance.
    • To Test your internet download and upload speed:
      • Go to Google.
      • Search for Internet Speed Test.
  • Video cameras must be used during all interviews, as well as during the initial week of orientation if hired.

 

This position is intended for pipelining. We will accept applications on an ongoing basis.

 

The pay range for this position is $65,000 – $75,000 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at HMS, a Gainwell Company. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

 

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with HMS, a Gainwell Company, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about HMS, A Gainwell Technologies Company at our company website and visit our Careers site for all available job role openings.

 

HMS, a Gainwell Company is committed to a diverse, equitable, and inclusive workplace. We are proud to be an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. We celebrate diversity and are dedicated to creating an inclusive environment for all employees.

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