Review Nurse (Alaska)

Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at HMS, a Gainwell Company carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work flexibility, learning, and career development. You’ll add to your technical credentials and certifications while enjoying a generous, flexible vacation policy and educational assistance. We also have comprehensive leadership and technical development academies to help build your skills and capabilities.

 

Summary

The Review Nurse performs prior authorization reviews of admissions, procedures, services, and supplies to determine if there has been medical waste, fraud, or abuse for our Alaska based team.

Your role in our mission

• Perform prior authorization reviews of admissions, procedures, services, and supplies to determine medical necessity, appropriateness, and reasonableness of care while maintaining production goals and quality standards.
• Complete medical necessity and level of care reviews for requested services using the appropriate clinical criteria.
• Document decisions and rationale while maintaining pertinent clinical information in various medical management systems.
• Assists management with training new Utilization Review Nurses to include daily monitoring, mentoring, feedback, and education.
• Maintains current knowledge of clinical criteria guidelines and successfully completes required CEUs to maintain RN license.
• Responsible for attending training and scheduled meetings to enhance skills and working knowledge of clinical policies, procedures, rules, and regulations.
• Actively cross-trains to perform multiple review types to provide a flexible workforce to meet client needs.

What we're looking for

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• Active and unrestricted United States nursing (RN) license required
• 5+ years clinical or in facility experience
• 1+ year of utilization review experience
• Experience in InterQual or Milliman criteria helpful
• Willing to work full-time schedule

What you should expect in this role

• Remote (work from home) position and you must be within the continental United States of America.
• Specific hours and schedules will be determined by the supervisor and may be adjusted based on workload requirements. This is further discussed during interviews.
  • This position supports the Alaskan-based operations. Thus, you must be willing to work hours that are consistent with Alaska's standard workday hours.
• Gainwell provides all needed equipment for this role (Please be sure to have a physical address on your application where you can receive items.)
• To effectively work as a remote worker (work from home) with Gainwell, employees' Broadband Internet connections should have a minimum speed of 24MBS download and 8 MBS upload.  Greater speeds will of course provide better performance.
  • To Test your internet download and upload speed:
    • Go to Google.
    • Search for Internet Speed Test or click here.  
• Video cameras must be used during all interviews, as well as during the initial week of orientation if hired.
• When applying please attach a resume in English.

 

 

 

 

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The pay range for this position is $65,900.00 - $94,100.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at HMS, a Gainwell Company. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

 

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with HMS, a Gainwell Company, a