Registered Nurse Quality Management Consultant- REMOTE

A-Line Staffing is actively searching for Multiple RN's for a major healthcare company located anywhere in the United States. This is an exciting opportunity with a client that is looking to move fast for the right candidate. Please contact Brad Zidek at bzidek@alinestaffing.com for immediate consideration! Or call at 412-823-2500.

Job Description

A-Line is seeking MultipleRegistered Nurses . These positions are FULLY REMOTE. Must have Current and Active RN liscense.

RN Hours: 40hrs per week

RN Job Summary:

Responsible for the review and evaluation of clinical information and documentation. Reviews documentation and interprets data obtained from clinical records or systems to apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements for member and/or provider issues. Independently coordinates the clinical resolution with internal/external clinician support as required. Requires an RN with unrestricted active license - Reviews documentation and evaluates the necessity of provider requests but applying national and state based criterion thus conducting Medical Necessity Review. Staff may be required to contact the providers of record vendors or internal Aetna departments to obtain additional information.-Accurately applies review requirements to assure case is reviewed by a practitioner with clinical expertise for the issue at hand.-Commands a comprehensive knowledge of complex delegation arrangements contracts clinical criteria benefit plan structure regulatory requirements company policy and other processes which are required to support the review of the clinical documentation/information.-Pro-actively and consistently applies the regulatory and accreditation standards to assure that activities are reviewed and processed within guidelines.-Condenses complex information into a clear and precise clinical picture while working independently

Please contact Brad Zidek at bzidek@alinestaffing.com for immediate consideration! Or call at 412-823-2500.