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RN Reviewer
Location
United States
Posted
133 days ago
Salary
$33 - $35 / hour
Seniority
Mid Level
No structured requirement data.
Job Description
RN Reviewer
Atlas Travel & Technology Group - ATTG
This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The RN Reviewer position is a crucial role in our organization — in this role you are responsible for performing a full range of activities that will positively impact the organization and contribute to guiding the strategic operations for the company. As an RN Reviewer, you will: - Perform prospective review (prior authorization) admission, concurrent, and retrospective reviews according to established criteria and protocols to determine the medical appropriateness of the clinical requests from providers. - Work closely with Medical Directors and other Cohere Health staff to ensure appropriate cost-effective care by applying your clinical knowledge and critical thinking skills to assess the medical necessity of inpatient admissions, outpatient services and procedures, and provider out of network requests. - Review Commercial, Medicare, and Medicaid lines of business. - Be an agile and comprehensive thinker and planner and be able to work in an environment that is in flux. - Make a substantive mark in simplifying the way healthcare is delivered and contribute to an up and coming company with exponential growth opportunity. Qualifications - Strong communication and collaboration skills across remote teams. - Customer-focused mindset and ability to stay calm under pressure. - Adaptability in a fast-moving, startup environment. - Solid understanding of utilization and case management programs. - Organized, detail-oriented, and comfortable managing multiple priorities. - Knowledge of NCQA/CMS standards; proficiency with MCG (CareWebQI a plus). Requirements - Active, unencumbered RN license (state of residence). - 3+ years of clinical experience. - Utilization Management experience. - Experience in acute or post-acute settings. - Comfortable using Mac and Google Workspace. - Strong communication skills and continuous improvement mindset. - Preferred: HEDIS abstraction, Legal RN, or Utilization Review background. - Bachelor’s degree in Nursing, Business, or related field. Benefits - Fully remote opportunity with about 5% travel. - Medical, dental, vision, life, disability insurance, and Employee Assistance Program. - 401K retirement plan with company match; flexible spending and health savings account. - Up to 184 hours (23 days) of PTO per year + company holidays. - Up to 14 weeks of paid parental leave. - Pet insurance. Important to know about this role - This is a 100% remote role, and requires robust internet speeds (above 50 megabytes/second), including the ability to utilize zoom meeting software and to stream video. - The department is staffed seven days per week, 8am-8pm EST and shifts will be assigned based on need. - This is a full time, 40 hour per week opportunity. Interview Process - Internet Speed Test. - Behavioral Interview(s) with your Hiring Manager!
Job Requirements
- Strong communication and collaboration skills across remote teams.
- Customer-focused mindset and ability to stay calm under pressure.
- Adaptability in a fast-moving, startup environment.
- Solid understanding of utilization and case management programs.
- Organized, detail-oriented, and comfortable managing multiple priorities.
- Knowledge of NCQA/CMS standards; proficiency with MCG (CareWebQI a plus).
- Active, unencumbered RN license (state of residence).
- 3+ years of clinical experience.
- Utilization Management experience.
- Experience in acute or post-acute settings.
- Comfortable using Mac and Google Workspace.
- Strong communication skills and continuous improvement mindset.
- Preferred: HEDIS abstraction, Legal RN, or Utilization Review background.
- Bachelor’s degree in Nursing, Business, or related field.
Benefits
- Fully remote opportunity with about 5% travel.
- Medical, dental, vision, life, disability insurance, and Employee Assistance Program.
- 401K retirement plan with company match; flexible spending and health savings account.
- Up to 184 hours (23 days) of PTO per year + company holidays.
- Up to 14 weeks of paid parental leave.
- Pet insurance.
- Important to know about this role
- This is a 100% remote role, and requires robust internet speeds (above 50 megabytes/second), including the ability to utilize zoom meeting software and to stream video.
- The department is staffed seven days per week, 8am-8pm EST and shifts will be assigned based on need.
- This is a full time, 40 hour per week opportunity.
- Interview Process
- Internet Speed Test.
- Behavioral Interview(s) with your Hiring Manager!
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