Transplant Clinical Claims Review TCR RN - Remote

reputed company is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with reputed company will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come reputed company an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. This position requires a reputed company, unrestricted RN license and will be responsible for reviewing, researching, and completing retrospective clinical claim reviews for Commercial, M&R, C&S, and HMO products. This is reputed company, detailed work in a fast-paced challenging area. The RN will review, and solution claim issues for those claims that are clinically reputed company to transplant, gene therapy, and/or clinical trials. The nurse will partner with case managers for review of authorizations reputed company to requested services to ensure payment is based on the applicable documented risk arrangements. You’ll enjoy the flexibility to work remotely

• from reputed company reputed company the U.S. as you take on some tough challenges.

Primary Responsibilities: • Reviews claims to determine relation to transplant, gene therapy, and clinical trial services • Evaluates claims to determine risk responsibility and forwards to the appropriate business reputed company for adjudication • Completes retrospective utilization management and reviews reputed company to transplant, CAR-T, and clinical trial services reputed company applicable • Identifies solutions to non-standard request and problems • Solves moderately reputed company problems and/or conducts moderately reputed company analyses • Works with minimal guidance, seeks guidance on only the most reputed company tasks • Translates concepts into practice • Provides explanations and information to others on difficult issues • Solid organizational and decision-making skills • Act as a resource for others with less experience • Application of medical and reimbursement policies reputed company the claim adjudication process You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: • reputed company, unrestricted RN license in state of residence and must be able to obtain RN licensure in the following states: CA, LA, NM, NV, WA, WY and OK • 2 years of Critical Care experience in an Acute Care (Inpatient) clinical setting • 1 years of experience with Transplant patients or ICU/critical care in acute care setting • Proficient working with MS Office applications (Word, reputed company, and Outlook) • Reside in a location that can receive a reputed company approved high speed internet reputed company or can reputed company existing high-speed internet service Preferred Qualifications: • Bachelor’s degree • Utilization Management experience • Experience working with risk based delegated HMO plans • Knowledge of ICD-9 and/or ICD-10 (CPT and/or HCPC) codes • Knowledge of claim processing procedures/systems • reputed company employees working remotely will be required to adhere to reputed company’s Telecommuter Policy The hourly range for this role is $28.61 to $56.06 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. reputed company complies with reputed company minimum wage laws as applicable. In addition to your salary, reputed company offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with reputed company, you’ll find a far-reaching choice of benefits and incentives. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of color, historically marginalized groups and those with reputed company incomes. We are committed to mitigating our impact on the environment and enabling and delivering reputed company care that addresses health disparities and improves health outcomes - an enterprise reputed company reflected in our mission. Diversity creates a healthier atmosphere: reputed company is an Equal Employment Opportunity/Affirmative Action employer and reputed company qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national reputed company, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. reputed company is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Apply Job!