Nurse RN 5
08:00 AM - 05:00 PM
2 months 19 days (Possibility of extension or conversion based on business)
Remote in California

Summary:
The main function of the nurse is to provide and coordinate patient care, educate patients and the public about various health conditions, and provide advice and emotional support to patients. This person is responsible for providing simple medical care and treatment to patients.

Job Responsibilities:
Day to Day Responsibilities of this Position and Description of Project:

Performs prospective reviews and first level determination approvals for members using FEP and  evidenced based guidelines, policies and nationally recognized clinal criteria across FEP’s line of business. Ensures diagnosis matches ICD 10 codes.

Triages and prioritizes cases to meet required, regulatory turn-around times. Expedites access to appropriate care for members with urgent needs using expedited review process.

Develops determination recommendations. If the recommendation is to deny a specific treatment, presents cases to Medical Director (MD) as required.

Communicate determinations to providers and/or members to be in compliance with state, federal and accreditation requirements.

Develops and reviews member centered documentation and correspondence reflecting determinations in compliance with regulatory and accreditation standards.

Identifies potential quality of care issues, service or treatment delays and intervenes as clinically appropriate.

Identifies potential Third Party Liability and Coordination of Benefit cases and notifies appropriate internal departments.


Identifies potential quality of care issues, service or treatment delays and intervenes or as clinically appropriate.

Skills:
• Verbal communication skills, attention to detail, and problem solving skills.
• Verbal and written communication skills, attention to detail, and problem solving skills.
• Basic ability to work independently and manage one’s time.
• Basic knowledge of the information and techniques needed to diagnose and treat human injuries and diseases.
• Basic ability to analyze data and accurately document and record results.
• Understands the Nurse Practice Act and legal consequences of nursing action.

Education/Experience:
• Associate’s degree in nursing required. Bachelor’s degree preferred.
• Nursing license required.
• 10+ years experience required 
 
At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws. This position's pay range is $60.00/hr - $66.00/hr.