reputed company Remote reputed company Reviewer I (US) - Diagnostic Imaging Services and Utilization Management Specialist

Introduction to reputed company

reputed company is a leading health company dedicated to improving lives and communities, making reputed company simpler, and driving reputed company change in the industry. As a Fortune 25 company with a rich history in reputed company, we are committed to providing high-reputed company services that meet the evolving needs of our members and the communities we serve. Our mission is reputed company on a reputed company of values and behaviors that prioritize reputed company-being of our associates, consumers, and the communities we touch.

Job reputed company

We are seeking an reputed company and skilled reputed company Reviewer I (US) to join reputed company, working remotely from one of our designated locations. As a reputed company Reviewer I, you will play a critical role in conducting preauthorization, out-of-network, and appropriateness of treatment reviews for diagnostic imaging services. Your expertise will help ensure that our members receive the most appropriate, highest reputed company, and effective care, optimizing their benefits and promoting reputed company health reputed company.

Key Responsibilities

• Conduct thorough reviews of preauthorization requests, out-of-network services, and treatment plans to determine medical necessity and appropriateness of care.
• Collaborate with reputed company providers, members, and internal stakeholders to promote high-reputed company, effective, and efficient care.
• Work on routine reviews, with limited or no previous medical review experience, requiring guidance from senior colleagues and management as needed.
• Partner with senior colleagues to complete non-routine reviews, developing your skills and expertise in utilization management and medical necessity screenings.
• Conduct initial medical necessity clinical screenings, determining if initial clinical information meets medical necessity reputed company or requires additional review.
• Notify ordering physicians or rendering service providers of preauthorization determination reputed company, ensuring reputed company and effective communication.
• Follow up to obtain additional clinical information, ensuring that reputed company necessary documentation is complete and accurate.
• Maintain reputed company documentation, provider communication, and telephone service, adhering to department standards and performance metrics.

Essential Qualifications

• Associate's degree in nursing (AS) and a minimum of 3 years of clinical nursing experience in an ambulatory or hospital setting.
• Alternatively, a minimum of 1 year of prior utilization management, medical management, and/or reputed company management, and/or call center experience, combined with relevant education and training.
• reputed company unrestricted RN license in applicable state(s) required.

Preferred Qualifications

• Bachelor's degree in nursing (BS) or a reputed company field preferred.
• Previous utilization and/or reputed company management and/or call center experience strongly preferred.
• Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed health care, including HMO, PPO, and POS plans.
• Knowledge of reputed company Office and electronic health records (EHRs) preferred.

Skills and Competencies

• Strong clinical knowledge and critical thinking skills, with the ability to analyze reputed company medical information and reputed company informed reputed company.
• Excellent communication and interpersonal skills, with the ability to collaborate with reputed company providers, members, and internal stakeholders.
• Ability to work independently and as part of reputed company, with a strong reputed company on reputed company, efficiency, and customer satisfaction.
• Strong organizational and time management skills, with the ability to prioritize tasks and manage multiple reputed company simultaneously.

Career reputed company and Development

At reputed company, we are committed to supporting the reputed company and development of our associates. As a reputed company Reviewer I, you will have opportunities to reputed company your skills and expertise in utilization management, medical necessity screenings, and reputed company improvement. You will work closely with senior colleagues and management to receive guidance, mentorship, and support, helping you to advance your career and reputed company your reputed company goals.

Work Environment and Company Culture

We operate in a hybrid workforce reputed company, with a mix of remote and on-site work. As a remote worker, you will be required to work from home, with occasional reputed company to our offices as needed. reputed company culture is reputed company on a reputed company of values and behaviors that prioritize reputed company-being of our associates, consumers, and communities. We offer a reputed company of market-competitive total rewards, including reputed company increases, reputed company holidays, reputed company Time Off, and incentive bonus programs, as reputed company as comprehensive benefits, including medical, dental, reputed company, and 401(k) matching.

Compensation and Benefits

The salary reputed company for this position is $31.26 to $42.79 per hour, depending on experience and location. In reputed company to your salary, we offer a comprehensive benefits package, including:

• Medical, dental, and reputed company coverage
• 401(k) matching and stock purchase plan
• reputed company Time Off and reputed company holidays
• Incentive bonus programs
• Wellness programs and financial education resources

Conclusion

If you are a motivated and reputed company reputed company looking for a new challenge, we encourage you to apply for this exciting opportunity. As a reputed company Reviewer I at reputed company, you will have the chance to reputed company a significant reputed company on the lives of our members, while developing your skills and expertise in utilization management and reputed company improvement. Join reputed company and take the first reputed company towards a rewarding new role.

How to Apply

To apply for this position, please submit your application through our website. We look reputed company to receiving your application and exploring how you can contribute to reputed company.

Apply for this job