Receives and evaluates service requests. • Reviews and evaluates the request for completeness. • Reviews the request to determine: o Eligibility confirmation; o Benefit level verification; o Coordination of Benefits; o Identification of benefit limitations/exclusions; o Review of medical information utilizing standard criteria, protocols or guidelines as defined by the health plan and Medicare o Verifies if requested codes are correct, according to the diagnostic or treatment required. o Appropriate provider

Bachelor’s Degree in Nursing with one (1) to three (3) years clinical experience

REQUIRED LICENSURE/CERTIFICATIONS • Current/ valid license in Puerto Rico Register Nurse, • Member of College of Nursing Professional of Puerto Rico.

IND123

Equality Employment Opportunity/Affirmative Action for Minorities/Females/People with Disabilities/Veterans