Case Manager Position Available In [Unknown county], New Jersey
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Job Description
Top National Healthcare company is hiring a Registered Nurse to work Prior Authorizations! 100% Remote role Responsible for clinical criteria prior authorization setup, which takes client clinical policy requirements and creates the prior authorization request sent to prescribers. This could include questions such as (but not limited to) “is the patient 18, does this patient have certain medical conditions; has the patient tried and failed these alternative medications etc.”The creation of questions and answers along with other additional configuration will allow prescribers to answer questions leading to either an approval or denial.
Clinicians are also responsible for creating and coding denial rationales sent to prescribers and patients.
The system leveraged for this coding is a web-based platform proprietary to ESI, and selected contractor will be trained on how to leverage this platform.
Additionally, the individuals should have strong skills with Microsoft office, particularly excel.
Configuration support will be for both pharmacy and medical criteria and will require good creative problem-solving skills to ensure appropriate setup to meet client needs and maximum operation efficiency.
Consultative support in explaining setup and system requirements might be needed if discussing criteria setup with other internal ESI business partners.
An individual with strong and effective communication skills is highly desired.
Skills:
Communication, MicroSoft Office, Organization, Self-Driven, Collaboration Qualifications:
Demonstrates ‘Team Player’ and collaborative skills within internal and external teamsTakes risks by thinking strategically about problems and challenges within their domainCommunicates effectively within peer group and subordinate groupsHolds oneself accountable for designated client relationships and the delivery of requests associated to service.
Capable of & develops robust operational controls to maximize service levels.
Able to identify the needs of clinical system or process changes to help enhance service levels.
Ability to comprehend and articulate the importance of assigned responsibilities and controls.
Able to mitigate concerns of business partners within direct scope of responsibility.
Able to clearly communicate directly with clients when providing consultative services
REQUIREMENTS
Requires RN license that is in good standing as required by the state in which work is performedExcellent Written communication skillsPrior Authorization experienceBachelors degree in NursingBe a quick learner, and pick up systems relatively fast.
Self motivated and works well on their own
SCHEDULE
Monday – Friday 9am – 5:30am EST (30 minute unpaid lunch) Training hours will be the same 100% Remote Contract to start
Job Types:
Full-time, Contract, Temporary Equal Opportunity Employer:
Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.
At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact HRsupport@randstadusa.com. Pay offered to a successful candidate will be based on several factors including the candidate’s education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility). This posting is open for thirty (30) days. job detailssummary$35 per hourcontractcategorynursing & allied healthreference504914job details Top National Healthcare company is hiring a Registered Nurse to work Prior Authorizations! 100% Remote role Responsible for clinical criteria prior authorization setup, which takes client clinical policy requirements and creates the prior authorization request sent to prescribers. This could include questions such as (but not limited to) “is the patient 18, does this patient have certain medical conditions; has the patient tried and failed these alternative medications etc.”The creation of questions and answers along with other additional configuration will allow prescribers to answer questions leading to either an approval or denial.
Clinicians are also responsible for creating and coding denial rationales sent to prescribers and patients.
The system leveraged for this coding is a web-based platform proprietary to ESI, and selected contractor will be trained on how to leverage this platform.
Additionally, the individuals should have strong skills with Microsoft office, particularly excel.
Configuration support will be for both pharmacy and medical criteria and will require good creative problem-solving skills to ensure appropriate setup to meet client needs and maximum operation efficiency.
Consultative support in explaining setup and system requirements might be needed if discussing criteria setup with other internal ESI business partners.
An individual with strong and effective communication skills is highly desired.
Skills:
Communication, MicroSoft Office, Organization, Self-Driven, Collaboration Qualifications:
Demonstrates ‘Team Player’ and collaborative skills within internal and external teamsTakes risks by thinking strategically about problems and challenges within their domainCommunicates effectively within peer group and subordinate groupsHolds oneself accountable for designated client relationships and the delivery of requests associated to service.
Capable of & develops robust operational controls to maximize service levels.
Able to identify the needs of clinical system or process changes to help enhance service levels.
Ability to comprehend and articulate the importance of assigned responsibilities and controls.
Able to mitigate concerns of business partners within direct scope of responsibility.
Able to clearly communicate directly with clients when providing consultative services
REQUIREMENTS
Requires RN license that is in good standing as required by the state in which work is performedExcellent Written communication skillsPrior Authorization experienceBachelors degree in NursingBe a quick learner, and pick up systems relatively fast.
Self motivated and works well on their own
SCHEDULE
Monday – Friday 9am – 5:30am EST (30 minute unpaid lunch) Training hours will be the same 100% Remote Contract to start
Job Types:
Full-time, Contract, Temporary Equal Opportunity Employer:
Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.
At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact HRsupport@randstadusa.com. Pay offered to a successful candidate will be based on several factors including the candidate’s education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility). This posting is open for thirty (30) days.
