RN Coverage Review Nurse – Work From Home

Job Summary

Job Type: Full-time

Salary: Competitive, based on experience

Company: HealthFirst Inc.

Location: Remote (Work From Home)

Benefits: Comprehensive health benefits, 401(k) matching, paid time off, professional development opportunities, and more.

Job Description

HealthFirst Inc. is seeking a dedicated and experienced RN Coverage Review Nurse to join our dynamic team. This remote position offers the flexibility to work from the comfort of your home while playing a critical role in ensuring our members receive the highest quality health care. If you are passionate about patient care and have a keen eye for detail, we invite you to apply.

Requirements

• Active RN license in good standing


• Minimum of 3 years of clinical nursing experience


• Experience with utilization review or case management preferred


• Strong knowledge of medical terminology and coding


• Excellent communication and analytical skills


• Proficiency in Microsoft Office Suite and electronic medical records (EMR) systems


• High-speed internet connection and a dedicated workspace

Responsibilities

• Conduct thorough coverage reviews to determine the medical necessity of services


• Collaborate with healthcare providers and insurance companies to ensure proper documentation


• Provide clear and concise recommendations based on clinical guidelines


• Maintain accurate records and documentation in compliance with company policies and regulations


• Participate in ongoing training and professional development opportunities

Benefits

• Comprehensive health benefits including medical, dental, and vision insurance


• 401(k) plan with company matching


• Generous paid time off and holiday schedule


• Professional development and continuing education support


• Flexible work-from-home schedule


• Supportive and collaborative team environment

Educational Qualifications

• Bachelor of Science in Nursing (BSN) preferred


• Active RN license in the state of residence


• Certification in case management (CCM) is a plus

Company Overview

HealthFirst Inc. is a leading provider of health care solutions, dedicated to improving the health and well-being of our members. We are committed to delivering personalized, high-quality care and support through our extensive network of healthcare professionals. Our mission is to empower individuals to take control of their health and achieve their wellness goals. Join our team and be part of a company that values innovation, compassion, and excellence in healthcare.

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