Medical Review RN

About the role

The Medical Review Nurse (MR, RN) manages THPC pre-authorization referrals for TH recipients, assists providers with referral information, and oversees the medical review process in collaboration with a Medical Clinician. Additionally, this position implements and administers the Deferred Services Program.

Responsibilities

• Manages THPC pre-authorization referrals for TH recipients
• Affords assistance to internal and external providers with referral information
• Oversight of the medical review process for THPC in conjunction with a Medical Clinician
• Implements and administers the Deferred Services Program

Requirements

• Minimum of a Bachelor of Science in Nursing or Associates of Science in Nursing
• Minimum of five (5) years' experience
• Valid driver's license
• Passes a background and suitability check according to Public Law 101-630 and the Indian Child Protection and Family Violence Prevention Act

Qualifications

CSKT Enrolled tribal members needing medical assistance not typically covered by the Paid Healthcare Program have the option of seeking deferred services program approval. These are services that have been rated by the THPC and CSKT enrolled members will be the population served. Occasionally special requests for deferred services coverage may be granted by the Business Office Executive Director or the THD Department Head.