Pre-Certification RN

Amazing Opportunity with one of the #1 Health Plan in the country!!!! They are looking for a RN to join onto their team.

Job Description:

• Will be working on a computer--multiple screens, sometimes with 13+ programs at one time
• Work with team to approve or deny requests and cases
• Consult with medical directors on difficult cases
• Review requests coming in from providers for DME, procedures, medication, home care, therapies
• Determine level of care by using InterQual
• Contact providers if sufficient information not provided--by phone or computer
• Escalate cases to Medical Directors for review

Qualifications:

• Active RN license in state of MA with no disciplinary action
• 3+ years of clinical experience
• 1+ year of experience working in a managed care setting
• Familiarity with CMS guidelines
• Experience with InterQual preferred, but not required

Work Environment:

• Office, cubical environment
• 100% of time sitting and using compute
• Individual work
• Also need to be able to work with a team--including other RNs, medical directors and coordinators

Training:

• Will spend several days working with clinical trainer in classroom setting learning computer systems
• Will team up with a preceptor in order to shadow cases
• Begin working easiest, most simple cases on own and reviewing with preceptor
• Add more complicated cases as able to handle workflow

About Aerotek:

Our people are everything. As a Best of Staffing® Client and Talent leader, Aerotek® Inc. has distinguished itself as a leader in recruiting and staffing services, by having a deep understanding of the intersection of talent and business. As a strategic partner to more than 17,000 clients and 300,000 contract employees every year, Aerotek's people-focused approach yields competitive advantages for its clients and rewarding careers for its contract employees. Headquartered in Hanover, Md., Aerotek operates a network of over 230 non-franchised offices with more than 6,000 internal employees dedicated to serving our customers. Aerotek is an operating company of Allegis Group, a global talent solutions provider. To learn more, visit .

Aerotek is acting as an Employment Agency in relation to this vacancy.