Experienced Utilization Reviews Appeals Registered Nurse – Remote Work from Home Opportunity in Managed Care Setting

Introduction to Workwarp and the Role At Workwarp, we are committed to transforming the healthcare landscape through innovative approaches and a patient-centric mindset. As a leader in managed care, we are seeking an exceptional Utilization Reviews Appeals Registered Nurse to join our dynamic team. This remote position offers the unique opportunity to work from the comfort of your own home, collaborating with our medical providers and internal teams to ensure seamless execution of duties. If you are a motivated and experienced registered nurse looking to level up your career, we invite you to explore this exciting opportunity further. About the Position As an Appeals & Claims UR Nurse , you will play a pivotal role in investigating and reviewing clinical appeals and post-claim cases. Your clinical expertise and established criteria will be crucial in assessing the medical appropriateness of healthcare services, including inpatient and lower levels of care admissions, as well as various outpatient and specialty services. Working closely with our team, you will ensure that all decisions are made with the highest standards of healthcare delivery in mind, adhering to Oscar Clinical Guidelines and Milliman Care Guidelines. Key Responsibilities Conduct thorough medical necessity reviews and level of care assessments for requested services, utilizing evidence-based guidelines and clinical expertise. Gather essential information through effective communication with members, providers, and internal stakeholders to evaluate clinical conditions and apply guidelines accordingly. Meet decision-making service level agreements (SLAs) and refer members for further care engagement when necessary, ensuring timely and appropriate interventions. Ensure compliance with all relevant laws, regulations, and company policies, maintaining the highest level of professionalism and integrity in all interactions. Perform other assigned duties as needed, contributing to the team's objectives and the company's mission to transform healthcare. Qualifications and Requirements To be successful in this role, you must hold an active, unrestricted RN licensure from the United States in one of the specified states or possess an active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC). An Associate Degree in Nursing, Graduate of Accredited School of Nursing, or successful completion of a Diploma Program in Practical Nursing from an Accredited School of Nursing is required. Additionally, you should have: At least 1 year of utilization review experience in a managed care setting. 2+ years of clinical experience, including a minimum of 1 year of clinical practice in an acute care setting such as the ER or hospital. Ability to obtain additional state licenses as required by business needs, demonstrating flexibility and adaptability in a rapidly changing healthcare environment. Preferred Qualifications While not required, the following qualifications are highly desirable: BSN qualification, indicating a higher level of academic achievement and preparation for advanced nursing roles. Previous experience in conducting concurrent or inpatient reviews for a managed care plan, demonstrating expertise in utilization review and management. Career Growth Opportunities and Learning Benefits At Workwarp, we are committed to the growth and development of our employees. As a Utilization Reviews Appeals Registered Nurse, you will have access to: Ongoing training and education to enhance your skills and knowledge in utilization review and managed care. Opportunities for professional advancement, including leadership roles and specialized positions within the company. A collaborative and dynamic work environment that fosters innovation, creativity, and teamwork. Work Environment and Company Culture We pride ourselves on maintaining a work environment that is inclusive, supportive, and empowering. Our company culture is built on the principles of: Diversity and inclusion, recognizing the value of unique perspectives and experiences. Integrity and transparency, ensuring that all interactions are conducted with the highest level of professionalism and ethics. Innovation and creativity, encouraging employees to think outside the box and develop novel solutions to complex problems. Compensation, Perks, and Benefits We offer a competitive total rewards package, including: A base pay range of $35 to $45.94 per hour, reflecting our commitment to fair and equitable compensation. Eligibility for employee benefits, including medical, dental, and vision coverage, paid holidays, sick leave, parental leave, 401(k) participation, life and disability insurance, and wellness benefits. Monthly vacation accrual of up to 10 days per year, recognizing the importance of work-life balance and relaxation. Equal Opportunity Employer Statement We are an equal opportunity employer, dedicated to fostering an inclusive environment where everyone feels empowered to be their authentic selves. We believe that diversity and inclusion are essential to driving positive change and transforming healthcare, and we welcome applications from qualified candidates of all backgrounds. Pay Transparency Final compensation offers, within the specified base pay range, are determined based on factors including relevant skills, education, and experience. We are committed to transparency and fairness in our compensation practices, ensuring that all employees are rewarded for their contributions and achievements. Conclusion and Call to Action If you are a motivated and experienced registered nurse looking to take your career to the next level, we invite you to apply for this exciting opportunity. As a Utilization Reviews Appeals Registered Nurse at Workwarp, you will have the chance to make a meaningful difference in the lives of our members, while also advancing your skills and knowledge in a dynamic and supportive environment. Don't miss this opportunity to join our team and contribute to our mission to transform healthcare. Apply now and let's discuss how you can become a vital part of our success story. Apply for this job