RN Clinical Review Specialist

Position Summary: 

As a Registered Nurse Clinical Review Specialist at Pure Healthcare, you are responsible for ensuring timely approval and renewal of patient care services to allow Pure Healthcare to meet patient care needs. This occurs through communication and coordination between the patient, the patient’s physician, and our clinics. The Clinical Review Specialist supports and creates positive environments through a personal commitment to the Company’s vision and values.

Key Responsibilities 

·         Reviewing orders from authorizations

·         Communicating with referring providers

·         Ensuring timely approval and renewal of patient care services

·         Assisting Pure Healthcare in meeting all patient care needs

·         Being detail oriented with urgency to complete authorizations for patients

·         Contributing to company culture of being grateful and passionate serving patients

·         Participates in performance improvement activities for the enhancement of care delivery offering suggestions and assistance towards the continuous quality improvement of patient care 

·         Demonstrates a thorough knowledge of and complies with all policies and procedures related to the performance of job duties 

Benefits 

·         Competitive health, dental and vision

·         Competitive Pay (We strive to be generous in our pay for skills you already have)

·         PTO (14 days a year in your first year)

·         1 community service paid day off a year to do a service project of your choice. 

·         401k

Required Knowledge and Skills 

·         Minimum 1-2 years nursing experience 

·         Experience with insurance and prior authorizations

·         Experience writing emails or letters for medical requests 

·         Demonstrates clear communication and effective collaboration to optimize patient care and clinic operations 

·         Excellent customer service skills 

·         We want nurses who are eager to learn and grow with our rapidly expanding organization 

·         Ability to collaborate with others and offer outstanding customer service 

Education/Licensure/Technical Requirements 

·         RN Degree, BSN Preferred 

·         Current nursing license for applicable state 

·         BLS Certification required within 30 days of hire  

·         Ability to meet U.S. employment and eligibility requirements