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Responsibilities:

  • Review and authorize requests for elective, direct, ancillary, urgent, and emergency services.
  • Contact medical and support personnel to recommend alternative treatment and service levels.
  • Establish and communicate discharge planning needs with appropriate entities.

Qualifications:

  • Registered Nurse with current unrestricted license required.
  • Minimum 2 years' clinical experience in acute care, discharge planning, case management, or utilization review.
  • Minimum 1 year health insurance or managed care environment preferred.

Skills & Competencies:

  • Excellent written and verbal communication and customer service skills.
  • Working knowledge of Microsoft Office Suite.
  • Ability to apply clinical criteria and knowledge of accreditation standards.

Work Environment:

  • Remote work across multiple time zones.
  • Long periods of sitting/standing in front of a computer using video technology.
  • Occasional travel may be required.

Healthedge

HealthEdge provides AI-powered operational infrastructure for health insurance companies, helping them modernize operations and compete effectively. The company is expanding and investing in its people, offering opportunities to shape the future of healthcare technology.

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