Registered Nurse in US-Remote

Remote Role

Employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware

Job Summary:

• Review medical documentation to achieve results in accurate clinical determination based upon scope of practice.
• Reviews professional medical claims policy related issues or claims in pending status.
• Make determinations based on clinical reviews, along with medical policy guidelines, federal, state and company guidelines.
• Prepare cases for external and internal review.
• Provision of timely and accurate responses to inquiries from the Claim Policy teams in relation to courtesy
• Reviews claims pending for medical review, and appeals inquiries.
• Routing determinations to appropriate area.
• Partners with claims policy analysts in order to assure accurate claims adjudication.

Education & Experience Required:

• Requires a NJ State Registered Nurse License or compact state license. MD including non board certified, but certified abroad. Prefers a BSN
• Prefer a minimum of 3 years clinical experience.
• Prefer a minimum of 3 years business/insurance experience.
• Additional licensing, certifications, registrations:
• Prefer certification in medical coding.

Specialized knowledge/skills:

• Prefer knowledge of client product lines.
• Prefer knowledge of Workman's Compensation, Medicare, COB, no fault.
• Require strong knowledge of Microsoft Office Products.
• Team Player, Strong Analytical, good Written and Verbal Communication Skills, Interpersonal Skills.

Rangam Consultants is a minority, women-owned, disability workforce solutions global organization. Specialized in attracting and retaining talents globally for a rewarding career in IT, Engineering, Scientific, Clinical, Healthcare, Administrative, Finance, Business Management, and many more, while integrating veterans and individuals with disabilities into the workforce. Indeed, we connect career aspirants to relevant job opportunities, be it jobs in USA, UK, India, or Ireland. Also remote jobs, work-from-home jobs, or contract jobs in different verticals and industries.
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