- Specialty: Utilization Review
- Job type: Full-time
- Salary: $26 – $57 / hr
- License states: Any US
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At a glance
Hybrid RN prior-authorization review role in Raleigh, NC, supporting the state Medicaid program. Applies DHB Clinical Coverage Policy to private duty nursing and durable medical equipment requests, meeting daily SLA and quality targets. Requires an active RN license and 2+ years of related experience.
Regular
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Ancillary Health
Collaboration, Communication, Health Care, Medical Documentation, Nursing
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2 + years of related experience
No
HEALTHCARE CLAIMS EXAMINER
Solve real-world challenges that impact the frontlines of public health, life science, and clinical research initiatives as a Healthcare Claims Examiner at GDIT. You’ll support the mission and grow with it, building a meaningful career in health. The candidate for this position will be required to perform prior approval reviews under the private duty nursing and the durable medical equipment prior approval review programs. The Division of Health Benefits (DHB) Clinical Coverage Policy is expected to be utilized and referenced in adjudicating the prior approval requests. The candidate will be expected to meet GDIT's service level agreement (SLA) with DHB in each of their assigned areas of review.The average quantity SLA goal is 20-30 reviews each day. The candidate will be expected to meet the quality review expectations on at least 95% of cases reviewed monthly. Clear written denial summaries of resident reviews and additional information request is required. Strong organizational, analytical, decision making and leaderships skills are desired.
MEANINGFUL WORK AND PERSONAL IMPACT As a Healthcare Claims Examiner, the work you’ll do at GDIT will be impactful to the mission of our customer. You will play a crucial role in determining the level of services needed for prior approval requests.
● Collaborate with other team members. ● Drive corporate goals. ● Utilize DHB policies and NCTracks system.
WHAT YOU’LL NEED TO SUCCEED Bring your nursing expertise and drive for innovation to GDIT. The Healthcare Claims Examiner must have: ● Education: Bachelor of Arts/Bachelor of Science or Associate Degree in Nursing ● Experience: 2+ years of related experience ● Technical skills: computer and communication skills ● Security clearance level: None. ● US citizenship required ● Role requirements: RN License
GDIT IS YOUR PLACE At GDIT, the mission is our purpose, and our people are at the center of everything we do. ● Growth: AI-powered career tool that identifies career steps and learning opportunities ● Support: An internal mobility team focused on helping you achieve your career goals ● Rewards: Comprehensive benefits and wellness packages, 401K with company match, and competitive pay and paid time off ● Community: Award-winning culture of innovation and a military-friendly workplace
OWN YOUR OPPORTUNITY Explore a career in health at GDIT and you’ll find endless opportunities to grow alongside colleagues who share your sense of purpose for making a difference.
The likely salary range for this position is $60,350 - $81,650. This is not, however, a guarantee of compensation or salary. Rather, salary will be set based on experience, geographic location and possibly contractual requirements and could fall outside of this range.
40
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Hybrid
USA NC Raleigh
Our benefits package for all US-based employees includes a variety of medical plan options, some with Health Savings Accounts, dental plan options, a vision plan, and a 401(k) plan offering the ability to contribute both pre and post-tax dollars up to the IRS annual limits and receive a company match. To encourage work/life balance, GDIT offers employees full flex work weeks where possible and a variety of paid time off plans, including vacation, sick and personal time, holidays, paid parental, military, bereavement and jury duty leave. To ensure our employees are able to protect their income, other offerings such as short and long-term disability benefits, life, accidental death and dismemberment, personal accident, critical illness and business travel and accident insurance are provided or available. We regularly review our Total Rewards package to ensure our offerings are competitive and reflect what our employees have told us they value most.
As part of the hiring process, we will ask you to complete an identity verification process that leverages advanced biometrics and artificial intelligence to ensure authenticity and protect against identity fraud. You are expected to be on camera during virtual interviews. We reserve the right to take your picture to verify your identity and prevent fraud. By proceeding, you authorize the collection, processing, and use of your biometric data for identity verification and security purposes.
We are GDIT. A global technology and professional services company that delivers technology solutions and mission services to every major agency across the U.S. government, defense and intelligence community. Our 26,000 experts extract the power of technology to create immediate value and deliver solutions at the edge of innovation. We operate across 50+ countries worldwide, offering leading mission-ready capabilities in AI, cloud, cyber and software development.
Join our Talent Community to stay up to date on our career opportunities and events atgdit.com/tc.
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