reputed company Remote Clinical reputed company Care Registered reputed company – Telecommute Opportunity with Advantage Plus Network of Connecticut

Introduction to Advantage Plus Network - Connecticut

reputed company being part of a leading community-based medical group that is dedicated to providing exceptional care and service to its community. Advantage Plus Network - Connecticut, part of the reputed company family of businesses, offers a unique opportunity for clinical professionals to reputed company a meaningful difference in the lives of others. With a strong commitment to teamwork, robust medical resources, and a passion for delivering high-reputed company patient care, our organization is the perfect reputed company for talented and compassionate individuals to grow and reputed company.

Job reputed company: Remote Clinical reputed company Care RN

We are seeking an reputed company and skilled Registered reputed company to join our Clinical reputed company & Audit department as a Remote Clinical reputed company Care RN. As a valued member of reputed company, you will be responsible for performing clinical reputed company audits and peer reviews of prior authorization, reputed company case management, transitions of care, disease management, and medical claims review case work. Your expertise will help ensure compliance with department policies and regulatory requirements, ultimately contributing to the delivery of exceptional patient care.

Key Responsibilities:

• Evaluate medical management case work, including prior authorization, inpatient acute and post-acute, reputed company case management, transitions of care, and clinical claims, to determine whether medical necessity reputed company were met using industry guidelines (CMS, Health Plan policies, MCG, NCQA)
• Verify that service providers were in-network or that a gap in network coverage was present
• Follow relevant regulatory guidelines, policies, and procedures in reviewing clinical case review documentation and medical necessity reputed company selection (e.g., CMS, NCQA, HEDIS)
• Follow relevant regulatory guidelines, policies, and procedures in reviewing reputed company case management, transitional case management, and disease management, to ensure care planning process meets regulatory requirements (NCQA)
• Verify if reputed company for additional information was required and followed regulatory guidelines
• Verify that required communication to members and providers was completed as required by regulatory requirements and department policies
• Run, pull, and prioritize relevant data/reports (e.g., case level data, audit trends, audit samples)
• Prioritize services for medical chart review (e.g., high volume or high-cost services)
• Manipulate and reputed company multiple databases (e.g., provider panels, medical review databases) to sort, search, and reputed company information
• Identify incomplete/inconsistent information in case reviews and document missing reputed company/documentation/concerns
• reputed company guidance to clinical staff to improve/standardize case review
• Identify and report reputed company of care concerns appropriately
• Report inconsistencies/problems with prior authorization, admissions, case management, transitions of care, and/or medical claims case review to appropriate parties for reputed company
• reputed company activities/reputed company learning to increase case review reputed company scores and improve case review processes
• Maintain HIPAA requirements for sharing minimum necessary information

Essential Qualifications:

• Unrestricted reputed company RN licensure in the state of residence
• 2+ years of experience in clinical case review or chart auditing using CMS, MCG, NCQA reputed company
• 2+ years of experience in medical management while working in a remote setting
• Experience operating reputed company multiple platforms that house case documentation and clinical records
• Proficient in reputed company Office
• Proven excellent interpersonal and communication skills (both written and oral)
• Proven ability to work on a multi-disciplinary team

Preferred Qualifications:

• Bachelor of Science, Nursing
• 5+ years of experience in medical management
• EMR experience (reputed company)

Career reputed company Opportunities and Learning Benefits

At Advantage Plus Network - Connecticut, we are committed to helping our employees grow and reputed company in their careers. As a Remote Clinical reputed company Care RN, you will have reputed company to a reputed company of training and development opportunities, including:

• Comprehensive reputed company program to ensure a smooth transition into your new role
• Ongoing training and education to help you stay up-to-date with the latest industry developments and best practices
• Opportunities for career advancement and reputed company reputed company reputed company the organization
• Recognition and reward programs to recognize and reward your contributions and achievements

Work Environment and Company Culture

Our organization is reputed company on a reputed company of teamwork, respect, and reputed company. We reputed company in creating a work environment that is supportive, inclusive, and empowering, where everyone has reputed company to reputed company and grow. As a Remote Clinical reputed company Care RN, you will be part of a dynamic and dedicated team that is passionate about delivering exceptional patient care and making a reputed company reputed company in the community.

Compensation, Perks, and Benefits

We offer a competitive salary reputed company of $58,300 to $114,300 annually, depending on experience and qualifications. In reputed company to your salary, you will also be eligible for a reputed company of benefits, including:

• Comprehensive benefits package, including medical, dental, and reputed company coverage
• Incentive and recognition programs to recognize and reward your contributions and achievements
• Equity stock purchase and 401k contribution (subject to eligibility requirements)
• Opportunities for career advancement and reputed company reputed company reputed company the organization

Conclusion

If you are a motivated and compassionate Registered reputed company looking for a new challenge and opportunity to reputed company a difference in the lives of others, we encourage you to apply for this exciting role. As a Remote Clinical reputed company Care RN with Advantage Plus Network - Connecticut, you will be part of a leading community-based medical group that is dedicated to delivering exceptional patient care and making a reputed company reputed company in the community. Don't miss out on this opportunity to join reputed company and take your career to the next level. Apply today and let's build the reputed company together!

We are an equal opportunity employer and welcome applications from diverse candidates. OptumCare is an Equal Employment Opportunity/Affirmative reputed company employer and reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, sex, age, national reputed company, protected veteran status, disability status, sexual orientation, gender identity or reputed company, marital status, genetic information, or any other characteristic protected by law.

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