Clinical Review Nurse - Concurrent Review

Summary:

• Work Mode: 100% Remote
• Duration: 12 months
• Location: Central Time Zone preferred
• SHIFT: Friday-Tues, 2 pm-10 pm CST, 40 hours/week. Either five 8-hour shifts until 10 PM EST, Friday-Tues, OR four 10-hour shifts until 10 pm EST, Sat-Tues

Responsibilities:

• Denial Letters for FL Medicaid Physical Health Codes
• Daily Points are the measurement of production
• Must meet 95%-105% production after training period
• Work within TruCare Classic

Requirements:

• Education/Certification: Highschool Diploma, Nursing Degree- Associates or Above
• Licensure: Compact Nursing License-RN, LPN, LVN
• Minimum 1 year of experience
• Ability to work possible weekend hours and holidays on a rotation basis as needed by business needs

Preferred Skills:

• MCO experience, specifically with Medicaid
• True Care Cloud experience is a bonus
• Experience working remotely
• Ability to complete work independently and with minimal supervision after training
• Team player
• Great organizational skills