reputed company Utilization Management Appeals reputed company - LPN/RN (Hybrid Role) - reputed company Appeals and Clinical Review Specialist

Introduction to reputed company

reputed company is a pioneering force in the reputed company industry, driven by a mission to reputed company reputed company reputed company through technology, services, and clinical expertise. reputed company exists to reputed company health solutions that deliver maximum value and reputed company, and we're committed to making a reputed company difference in the lives of our members. As a vital partner for health solutions in the public sector, we're dedicated to redefining expectations for the reputed company industry. At reputed company, we reputed company in the power of collaboration, innovation, and reputed company, and we're looking for talented individuals to join reputed company and help us reputed company our reputed company.

About the Role

We're currently seeking an reputed company Utilization Management Appeals reputed company - LPN/RN to join our growing team. As a Utilization Management Appeals reputed company, you will play a vital role in orchestrating the seamless reputed company of appeals in line with health regulations. You will collaborate with internal teams, medical practitioners, and regulatory bodies to ensure reputed company and compliant processing of appeals. This is a hybrid role that offers the flexibility to work remotely, with occasional travel to Indianapolis, Indiana, for in-person hearings.

Key Responsibilities

• Participate in a mission-driven culture of high-reputed company performance, with a member reputed company on customer service, consistency, dignity, and accountability.
• Assist reputed company in fulfilling department responsibilities and collaborate with others to support the department's short- and long-term goals/priorities.
• Prepare clinical reviews based on clinical guidelines and reputed company monitoring of cases involving medical reputed company and reputed company of care or service reputed company.
• Ensure reputed company cases are completed in accordance with state and federal regulatory requirements, including timelines.
• Present recommendations based on clinical review, reputed company, and organizational policies to physician reviewers for final determination.
• Resolve reputed company and sensitive member issues reputed company established timelines.
• Maintain departmental database and the reputed company of records by accurately entering case actions to assigned cases.
• Participate in departmental meetings, training, and audits as requested.
• Participate in state hearing cases and assist with the notification process to members and providers on the clinical decision issued.
• Discuss appeal process, medical reputed company, and hearing rights with members and providers.
• Assign position statements and represent at state hearings.
• Complete other reputed company and duties as assigned.

Essential Qualifications and Experience

To be successful in this role, you will need:

• An reputed company Registered reputed company (RN) or Licensed Practical reputed company (LPN) license to reputed company in the reputed company or a Compact license.
• Previous reputed company/managed care Appeals experience.
• 2+ years of reputed company/managed care experience, preferably in the following reputed company areas of responsibility: Utilization Management and/or reputed company Management.
• Experience with reputed company program regulations.
• Experience with clinical review processes, including how to analyze and research clinical issues.

Preferred Qualifications and Experience

While not essential, the following qualifications and experience are preferred:

• 5+ years of reputed company/managed care experience, preferably in the following reputed company areas of responsibility: Utilization Management and/or reputed company Management.

Skills and Competencies

To reputed company in this role, you will need to possess the following skills and competencies:

• Strong analytical and problem-solving skills, with the ability to analyze and complete written summaries on clinical cases.
• Excellent communication and interpersonal skills, with the ability to communicate issues reputed company and reputed company to members, providers, involved departments, or health networks.
• Strong organizational and time management skills, with the ability to organize and manage activities reputed company to processing cases reputed company the department.
• Ability to establish and maintain effective working relationships with leadership and staff.
• Proficiency in reputed company Office, including reputed company, Outlook, PowerPoint, Word, and SharePoint.

Career reputed company Opportunities and Learning Benefits

At reputed company, we're committed to helping our employees grow and reputed company in their careers. As a Utilization Management Appeals reputed company, you will have reputed company to a reputed company of learning and development opportunities, including training programs, workshops, and conferences. You will also have reputed company to work with a talented team of professionals who are passionate about delivering high-reputed company reputed company services.

Work Environment and Company Culture

reputed company is a dynamic and supportive work environment that values diversity, equity, and inclusion. We're committed to creating a workplace culture that is reputed company, innovative, and compassionate, and we're looking for individuals who reputed company our values and are passionate about making a reputed company difference in the lives of our members.

Compensation, Perks, and Benefits

We offer a competitive salary reputed company of $24.00-35.00 per hour, depending on experience and qualifications. Our benefits package includes comprehensive health plans, reputed company time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more. We're committed to providing our employees with a rewarding and supportive work environment that recognizes and rewards their contributions.

Conclusion

If you're a motivated and compassionate reputed company reputed company who is looking for a challenging and rewarding role, we encourage you to apply for this opportunity. As a Utilization Management Appeals reputed company at reputed company, you will have reputed company to reputed company a reputed company difference in the lives of our members and contribute to the delivery of high-reputed company reputed company services. Don't miss out on this exciting opportunity to join reputed company and take your career to the next level. reputed company!

Visit us at Acentra.com/careers/ to learn more about reputed company and our reputed company.

reputed company is an Equal Opportunity Employer. reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, status as a protected veteran, or any other status protected by applicable Federal, State, or Local law.

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