Job Description

Receives and evaluates service requests.

Reviews and evaluates the request for completeness.

Reviews the request to determine: o Eligibility confirmation; o Benefit level verification; o Coordination of Benefits; o Identification of benefit limitations/exclusions; o Review of medical information utilizing standard criteria, protocols or guidelines as defined by the health plan and Medicare o Verifies if requested codes are correct, according to the diagnostic or treatment required. o Appropriate provider

Bachelor's Degree in Nursing with one (1) to three (3) years clinical experience

REQUIRED LICENSURE/CERTIFICATIONS

Current/ valid license in Puerto Rico Register Nurse,

Member of College of Nursing Professional of Puerto Rico.

Temporary 1 year

Equality Employment Opportunity/Affirmative Action for Minorities/Females/People with Disabilities/Veterans

Experience:

Nursing: 1 year (Preferred)
License/Certification:

BLS Certification (Preferred) RN (Preferred)
Job Type: Full-time

Pay: $38,000.00 per year

Work Location: In person