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Registered Nurse RN Clinical Reviewer, Melbourne Florida

Company: eviCore healthcare
Location: Melbourne
Posted on: February 15, 2019

Job Description:

Summary Want to know what a \"day in the life\" looks like for an eviCore Registered Nurse Clinical Reviewer? Watch this video to learn more!

Responsible for all clinical certification activities, which include but are not limited to evaluating telephone, fax or WEB requests for authorization of clinical services from physician offices/and or imaging centers, comparing requests against established clinical protocols and authorizing services or referring requests for expert clinical review as appropriate. Reviews clinical information submitted by providers to appropriate criteria and standards and makes decision to issue a review determination or to refer to physician review if criteria are not met. Maintains current departmental standards related to productivity. Trains in clinical certification, utilization management, URAC and NCQA principles, policies, and procedures. Prepares program correspondence as needed. Serves as a resource for members calling for assistance. Makes outbound calls as required. Refers provider and member complaints, and appeals to appropriate departments. Maintains patient confidentiality in accordance with eviCore standards established in compliance with HIPAA and State regulations. Provides outstanding customer service ensuring callers receive the highest possible service. Runs and analyzes reports to ensure all tasks are completed in a timely fashion and meet regulatory requirements. Assists team members in departmental chats, by phone and in person. Acts as training assistant when assigned. Assist team members with questions, participates in team meetings. Can be assigned to projects to support the department as needed. Performs related duties as required.
Nurse, Registered Nurse, Florida, Registered Nurse, RN, Nursing Job
eviCore is committed to hiring and retaining a diverse workforce. We are an Equal Opportunity Employer, making decisions without regard to race, color, religion, sex, national origin, age, veteran status, disability, or any other protected class. Applicants must be able to pass a drug test and background investigation
Minimum Experience Required

  • Current, unrestricted license as RN in state of primary residence or appropriate compact state.
  • Must have at least 1 year of acute care, managed care, ER or ICU experience. Required Skills Must be able to sit through shift, demonstrate advanced proficiency in MS Office applications. Excellent communication skills both verbal and written; excellent problem solving and customer service skills are required. Must be self directed and highly motivated with an ability to multi-task. Excellent computer skills. Must type at least 30 WPM. Must be able to hear and speak on the phone for an entire shift

    Associated topics: coronary, infusion, intensive care unit, maternal, psychiatric, recovery, registered nurse, staff nurse, tcu, transitional

    Keywords: eviCore healthcare, Melbourne , Registered Nurse RN Clinical Reviewer, Melbourne Florida, Healthcare , Melbourne, Florida

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