
Healthcare Professional – RN
2 weeks ago
Nezda Technologies is currently seeking a Clinical Nurse Case Manager - USRN.
This position offers flexibility and autonomy in a remote work environment.
Key aspects of the role include conducting medical management review activities, ensuring member access to quality healthcare, and consulting with clinical reviewers to ensure high-quality care.
Qualifications- Active and Non-Active USRN License.
- At least 1 year of experience in clinical or hospital settings.
- Conduct UM pre-service, concurrent, retrospective, out-of-network, and appropriateness of treatment setting reviews.
- Review service requests for compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.
- Utilize client-specific criteria sets, medical policy, and clinical guidelines for decision making.
- Responsible for conducting medical management review activities that require reviewing clinical information against client-specific criteria.
- Ensure member access to medically necessary, quality healthcare in a cost-effective setting according to the contract.
- Consult with clinical reviewers and/or U.S. licensed medical directors to ensure high-quality, cost-effective care throughout the medical management process.
This opportunity provides a direct employment arrangement with no bond requirements.
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