Registered Nurse RN Clinical Reviewer, Melbourne Florida
Company: eviCore healthcare
Posted on: June 14, 2019
Want to know what a "day in the life" looks like for an eviCore
Registered Nurse Clinical Reviewer? Watch this video to learn
First 90 days of employment/training will need to be onsite at our
Melbourne, FL, call center
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. e, Registered Nurse,
Florida, Registered Nurse, RN, Nursing Job
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
* 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
* Excellent computer skills.
* Must type at least 30 WPM.
* Must be able to hear and speak on the phone for an entire
Our Company and What We Offer
eviCore healthcare is committed to making a positive impact on
healthcare, and also making a positive impact on our employees.
eviCore offers a variety of perks and benefits including, but not
* Flexible scheduling and work/life balance with remote and work
from home opportunities
* 3 weeks of PTO(starting) per year plus paid holidays
* Education assistance, tuition reimbursement and professional
* Health, dental, vision, and life benefits with employer funded
* Comprehensive employee discount program, onsite fitness
facilities, and smart casual dress code
* Paid Volunteer Community Service Days
* Ample opportunities for growth, advancement, and promotion
* 401k retirement plan with company match of 50% employee
contributions up to 6%
Keywords: eviCore healthcare, Melbourne , Registered Nurse RN Clinical Reviewer, Melbourne Florida, Healthcare , Melbourne, Florida
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