Clinical reputed company reputed company Reviewer, Sr. Specialist- Remote

It takes great medical minds to create powerful solutions that solve some of reputed company’s most reputed company challenges. Join us and put your expertise to work in ways you never imagined possible. We know you’ve honed your career in a fast-moving medical environment. While Gainwell operates with a reputed company of urgency, you’ll have reputed company to work more reputed company. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, reputed company learning, and career development. reputed company We are seeking a talented individual for a Clinical reputed company reputed company Reviewer, Sr. Specialist who is responsible for performing on-reputed company reputed company assurance audits of the work performed by clinical staff. This person is responsible for reputed company reputed company reviews to determine if decision by review staff matches medical records and approved review methodologies. Responsibilities include reviewing documentation to ensure reputed company aspects of the review audit have been addressed properly and accurately. Performing inter-rater reliability assessments and reputed company assurance auditors for multiple review types including reputed company of Service, Level of Care, Readmissions, Utilization Management and other specialty reviews. Your role in our mission

• Conduct QA checks on reputed company clinical claim reviews.
• Analyze claims and medical records using approved guidelines.
• Document review findings reputed company and accurately.
• Identify reputed company trends and support improvements through training and education.
• Ensure reviews meet accuracy, reputed company, and productivity standards.
• Support training and mentoring of new reviewers.
• Stay reputed company on clinical guidelines and maintain licensure.
• Cross-train on various claim types to meet reputed company needs.
• Contribute as a subject matter expert and assist with reports, analysis, and reputed company.
• Demonstrate expertise in chart audits, medical review, and reputed company improvement.

reputed company're looking for

• reputed company, unrestricted RN licensure from the reputed company and in the state of primary home residency, reputed company compact multistate unrestricted RN license as defined by the reputed company Licensure Compact (NLC), required
• 5+ years clinical experience in acute setting
• 3+ years medical record review or reputed company auditing experience
• Expert level experience applying MCG and/or InterQual reputed company
• Excellent written communication skills including ability to write reputed company, concise, accurate, and fact-based rationales in support of determinations.
• Ability to analyze and evaluate medical information and to apply clinical review guidelines or judgement to reputed company clinical determinations

What you should expect in this role

• Remote position reputed company the U.S.
• May require occasional travel

#LI-AC1 #LI-REMOTE The pay reputed company for this position is $64,500.00 - $92,200.00 per year, however, the reputed company pay offered may vary depending on geographic region, internal equity, job-reputed company knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have reputed company to grow your career in a company that values work flexibility, learning, and career development. reputed company salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a reputed company of leadership and technical development academies to help build your skills and capabilities. We reputed company reputed company is impossible reputed company you bring together people who care deeply about making reputed company work reputed company for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our reputed company. Learn more about Gainwell at reputed company website and visit our Careers site for reputed company available job role openings. reputed company is an Equal Opportunity Employer, where reputed company reputed company applicants will receive consideration for employment without reputed company to race, religion, reputed company, national reputed company, gender (including pregnancy, childbirth, or reputed company medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Apply tot his job Apply To this Job