This range is provided by Robert Half. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.
Base pay range
$47.50/hr - $55.00/hr
Description
Our high end client is currently seeking an experienced Registered Nurse (RN) for a fully remote, contract-based, non-clinical utilization management role. This position calls for meticulous knowledge and practice in inpatient and outpatient medical procedures, excluding radiology and home health. The ideal candidate will exhibit a deep understanding and experience with Medicare Advantage programs. Additionally, you will be expected to proficiently handle pre-certification, prior authorization, and pre-service tasks, often referred to as case management or care management.
Responsibilities
Utilize specialized knowledge on Local Coverage Determinations (LCD), National Coverage Determinations (NCD), Milliman Criteria (MCG), and InterQual in guiding decision-making processes.
Execute prior authorizations according to medical necessity and plan coverage guidelines.
Coordinate and perform case management across the continuum of care using a person-focused, Medicare Advantage model.
Manage acuity system operations, ensuring accuracy and completeness of data.
Communicate effectively with healthcare professionals to facilitate patient care.
Administer administrative responsibilities related to patient management and care.
Formulate patient treatment plans based on results from risk identification and analysis.
Requirements
Active RN licensure (required)
Solid background in inpatient and outpatient medical procedures (excluding radiology and home health)
Medicare Advantage experience (required)
Familiarity with terminologies such as Local Coverage Determinations (LCD), National Coverage Determinations (NCD), Milliman Criteria (MCG), and InterQual.
Experience with acuity systems will be an added advantage.
Excellent communication skills and strong clinical judgement.
We are looking for a dedicated Registered Nurse who is seeking a diverse and challenging role. If your experience aligns with the above requirements and you are enthusiastic about this unique opportunity, we encourage you to apply.
Robert Half is the world’s first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles.
Robert Half works to put you in the best position to succeed. We provide access to top jobs, competitive compensation and benefits, and free online training. Stay on top of every opportunity - whenever you choose - even on the go.
All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit