TRICARE Medical Review Nurse

Contract: 6-12 months

Location: Remote

Are you an experienced clinical nurse looking for a new way to apply your knowledge and skill sets? If you have had enough of long, exhausting hospital shifts while still getting to apply your nursing judgement, come join us! We are a team of international nurses looking for new members to help patients around the globe access necessary care.

💡 What you'll do?

As a Medical Review Nurse, you will collaborate closely with the TRICARE Program Administration Team and our global medical teams. Your primary responsibilities will include:

• Thoroughly reviewing medical reports to ensure accuracy, completeness, and appropriate medical care, promptly addressing any quality issues identified.
• Processing medical reports by entering concise and clear information into Salesforce.
• Utilizing your clinical expertise to conduct benefit reviews and authorize requested care.
• Closing cases where no further action is required and care has been completed.
• Efficiently distributing tasks to the relevant medical team's CRM (Salesforce) queue when immediate action is needed for beneficiaries in specific regions.
• Coordinating care by contacting beneficiaries via email.
• Collaborating with the Authorization Executive/Customer Service Executive team to handle daily caseloads requiring medical input.
• Escalating complex cases to the Medical Review Nurse Team Leader.
• Ensuring strict adherence to consent and confidentiality guidelines for all released medical information.
• Escalating any concerns or complaints to the Medical Review Nurse Team Leader.
• Being accessible and responsive to beneficiaries' and colleagues' inquiries and information requests.

✅ What do we need from you?

• Minimum of 2 years of bedside Clinical Nursing experience, preferably in an acute care environment
• Registered Nursing qualification (or equivalent) in your country of origin/residence
• Excellent written and oral proficiency in English
• Strong computer literacy, including proficiency in MS Office (Outlook, Teams, and Excel). Experience with Salesforce is a plus, though not required
• Prior experience in utilization and/or case management is a plus
• Authorization to perform the relevant Nursing health profession without professional supervision

🙌🏼 What do we offer?

• Impactful employment with a diverse and international company
• Permanent contract with a competitive salary
• Flexible working hours after the completion of the probation period – core hours from 10:00 to 14:00
• Company benefits (5 weeks of holiday, 3 sick days, Meal vouchers, Pension contribution, Benefit card, Multisport card…)