Job Actions

Job Information

Registered Nurse RN Clinical Reviewer, Melbourne Florida
Category: Health Care Industry , Insurance
  • Your pay will be discussed at your interview

Job code: lhw-e0-85686571

Company Profile

CareCore National

Contact Company

Local Information

Laugh while you Look

Sponsored Ads


  Job posted:   Sun Mar 11, 2018
  Distance to work:   ? miles
  1 Views, 0 Applications  
Registered Nurse RN Clinical Reviewer, Melbourne Florida

Want to know what a "day in the life" looks like for an eviCore Registered Nurse Clinical Reviewer? to learn more!

Responsible for all clinical certification activities, which include but are not limited to evaluating telephone, fax or WEB requests for authorization of clinical services from physician offices/and or imaging centers, comparing requests against established clinical protocols and authorizing services or referring requests for expert clinical review as appropriate. Reviews clinical information submitted by providers to appropriate criteria and standards and makes decision to issue a review determination or to refer to physician review if criteria are not met. Maintains current departmental standards related to productivity. Trains in clinical certification, utilization management, URAC and NCQA principles, policies, and procedures. Prepares program correspondence as needed. Serves as a resource for members calling for assistance. Makes outbound calls as required. Refers provider and member complaints, and appeals to appropriate departments. Maintains patient confidentiality in accordance with eviCore standards established in compliance with HIPAA and State regulations. Provides outstanding customer service ensuring callers receive the highest possible service. Runs and analyzes reports to ensure all tasks are completed in a timely fashion and meet regulatory requirements. Assists team members in departmental chats, by phone and in person. Acts as training assistant when assigned. Assist team members with questions, participates in team meetings. Can be assigned to projects to support the department as needed. Performs related duties as required.

Nurse, Registered Nurse, Florida, Registered Nurse, RN, Nursing Job

Minimum Experience Required

+ Current, unrestricted license as RN in state of primary residence or appropriate compact state.

+ Must have at least 1 year of acute care, managed care, ER or ICU experience.

Required Skills

Must be able to sit through shift, demonstrate advanced proficiency in MS Office applications. Excellent communication skills both verbal and written; excellent problem solving and customer service skills are required. Must be self directed and highly motivated with an ability to multi-task. Excellent computer skills. Must type at least 30 WPM. Must be able to hear and speak on the phone for an entire shift

Apply for this position online

Email this position to a friend

Sorry the Share function is not working properly at this moment. Please refresh the page and try again later.

Connect With Us!

Not ready to apply?for general consideration.

eviCore healthcare is an Equal Opportunity Employer

Career ID2018-4571

Career CategoryNursing

More Information »