We are looking for a talented Clinical RN to help build out our Preventive Health Management division by providing next level health insurance assistance and helping members navigate their health benefits to get the most out of the services available to them.
Who We Are
BeniComp is a team of talented and passionate leaders, dedicated to our mission of providing innovative health insurance solutions that empower organizations and employees to take control of their health.
We believe in prevention, transparency and integrity, aligning our work with the social good. We thrive through collaboration. Each person has a valuable and unique role to uphold as we overcome challenges, solve problems, and discover the limitless potential of our teamwork.
We are currently looking for individuals who share our mission of integrating primary and behavioral health care while providing access to all individuals. We focus on providing quality and compassionate care in order to assist our patients in living their best life. We are dedicated to the endless pursuit of excellence and treat everyone with dignity, humanity, and respect.
What You'll Do
In this position, you’ll provide precertification for inpatient hospitalizations and all outpatient procedures and services requiring authorizations. You’ll also perform telephonic and/or concurrent review of inpatient hospitalizations and extended courses of outpatient treatment. This process includes clinical judgement, utilization management, application of product benefits, understanding of regulatory requirements, and verification of medical necessity. Additionally, discharge planning and provider education are major components of this process.
- Analyze submitted information including clinical assessments, treatment plan, regulatory guidelines, medical necessity, and accrediting standards for all requests
- Analyzes unique situation of request, identifying appropriate guideline and regulatory requirements for each request
- Assess and process an adverse determination
- Ensures the timeliness of all adverse determinations within the regulations mandated
- Facilitates provider communication and education
- Creates communication pieces to providers which meet accrediting and regulatory guidelines for clinical content and readability levels describing decision making rationale for service requests and notifies providers through written correspondence
- Liaisons with internal and external managed care staff members
- Collaborates with all disciplines within the health plan to meet goals and objectives meeting with contracting and provider relations on routine basis
- Assess and refers potential case management cases
- Screens, identifies, and refers potential members to case management and evaluation for programs or coverage
- Ongoing assessment for quality indicators and concerns
- Identify potential quality of care issues, and/or fraud and abuse, and refers to appropriate departmen
- A Bachelor of Science in Nursing, Associate Degree in Nursing, or Diploma in Nursing (Bachelor of Science in Nursing is preferred)
- Registered Nurse (RN) license without restriction
- Three (3) years of nursing experience
- Managed Care experience as a Nurse Reviewer is required
- Prior MCG and/or Interqual experience required
- Excellent oral and written communication skills
- Ability to learn quickly and independently
- Ability to multitask and prioritize
- Team player
- Strong analytical and problem-solving skills
Salary: Will be discussed during interview process
Job Type: Full Time in Tampa Office (Currently working remotely due to COVID-19)
To Apply You Must: Submit an application with a current resume and cover letter.
BeniComp originated in Ft. Wayne, IN in 1962 by Don Short as Short Associates, Inc. Years later his son, Doug Short, built out the health division and began innovating. In 2014 BeniComp opened an office in Tampa dedicated to innovation and development in order to stay on the cutting edge of health technology and digital communication strategies.
We work with forward-thinking employer groups who have tremendous influence in the lives of tens, hundreds, or thousands of people who work for them. We want them to know we are on their side.
Our operations support the movement from reactive, conventional medicine practices to proactive, functional medicine strategies that empower people to take control of their health and reverse the chronic conditions that are socially and financially affecting the nation.
“The future of health is a health solution” - Doug Short, President & CEO
A future where people enjoy happier, healthier lifestyles.
To reduce chronic disease and healthcare spending in America by empowering people with data, prevention, and technology.