Healthcare Utilization Review Nurse

This is a fully remote position, open to applicants in Brazil.

📋 Description

• Evaluate medical authorization requests and provide favorable or unfavorable decisions within the bounds of technical expertise.

• Forward requests for specialized review based on the necessary expertise and needs.

• Support the administrative team by offering guidance on requests and workflows.

• Document observations, recommendations, and technical conclusions in writing for the relevant parties.

• Engage in team meetings to foster alignment and enhance processes.

• Adopt a strategic approach to analyzing and directing care-related demands.

• Ensure compliance, quality, and safety throughout healthcare utilization management processes.

⛳️ Requirements

• Bachelor's degree in Nursing.

• Active and unrestricted registration with the Regional Nursing Council (COREN), along with a Certificate of Ethical Standing.

• Proficient knowledge of Microsoft Office applications (Excel, Word, and PowerPoint).

• Exceptional verbal and written communication skills for developing clinical opinions and guidance.

• Strong urgency, objectivity, and strict adherence to procedures when managing requests.

• A mindset geared towards continuous improvement, with a desire to acquire new knowledge and training.

• Prior experience in healthcare utilization management, health insurance companies, or hospital environments.

• Comprehensive understanding of regulations and guidelines from the Brazilian National Supplementary Health Agency (ANS).

• Extensive experience collaborating with multidisciplinary teams.

• A postgraduate qualification in Nursing Audit, Healthcare Management, or a related discipline is preferred.

🏝️ Benefits

• Opportunity to be engaged as an independent contractor or through an employment contract.

• Affirmative opportunity for LGBTQIA+ individuals.

• Affirmative opportunity for women.

• Affirmative opportunity for Indigenous people.

• Affirmative opportunity for Black individuals.

• Affirmative opportunity for individuals aged 40 and above.

• Remote work flexibility.