Post Review Nurse – Health Services - Remote

Overview

As a Post Review Nurse, you will utilize clinical knowledge and expertise to interpret and appropriately apply medical policy, InterQual criteria, and benefit information to post-service claims in a production-based environment with timeframe and quality metrics.

In Short

• Utilize clinical knowledge for post-service claims review.
• Collaborate with internal teams to improve processes.
• Provide consultation for utilization management requests.
• Work independently and collaboratively in a fast-paced environment.
• Must have technology savviness, especially with Microsoft Office.
• Preferred candidates located in Iowa or South Dakota.
• Requires high-speed internet for remote work.
• Must have RN or LPN license in Iowa or South Dakota.
• 4+ years of clinical experience required.
• Strong communication and analytical skills are essential.

Requirements

• Completion of an Accredited RN or LPN Program.
• Active RN or LPN license in Iowa or South Dakota.
• 4+ years of clinical experience in acute care or outpatient settings.
• Knowledge of diagnosis and procedure coding systems.
• Strong problem-solving and analytical skills.
• Excellent written and verbal communication skills.
• Attention to detail and accuracy in assessments.
• Proficiency with computer software applications.
• Knowledgeable of regulatory standards and regulations.
• Ability to manage multiple priorities in a dynamic environment.

Benefits

• Flexible remote work options.
• Collaborative work environment.
• Opportunities for professional growth.
• Comprehensive benefits package.
• Supportive team culture.
• Commitment to sustainability and innovation.
• Focus on member well-being.
• Access to training and development resources.
• Engagement in meaningful work.
• Equal opportunity employer.