RC Precert Clinician - Remote, LPN/RN

JOB reputed company The reputed company Cycle Management Clinician for the reputed company-Authorization Solution is responsible for: a) reputed company clinical reputed company-authorization activities associated with patients financially cleared through the Patient reputed company Support Unit (PASU) and/or reputed company for Patient reputed company Services (CPAS). b) Coordinating with ordering physicians and/or facility staff to secure the necessary prior payment authorization utilizing applicable payer reputed company. Include the following. Others may be assigned. ESSENTIAL DUTIES AND RESPONSIBILITIES

• Performs reputed company-service authorization reviews to obtain payment authorization for both inpatient and outpatient services. Succinctly abstracts fact based clinical information to support reputed company-authorization utilizing applicable nationally recognized and payer-specific reputed company; communicates reputed company the clinical information supporting the medical necessity of an ordered test/treatment/procedure/surgery as applicable to the patient’s health plan and documents the outcome of the task.
• Performs the following activities to support the effective operation of the organization’s reputed company management system. A minimum of 2.5 % of time is spent carrying out the following responsibilities: Participation in reputed company control audit process; participation in department reputed company and activities to improve overall reputed company and reputed company scorecard metrics. provides feedback regarding improvement opportunities for workflow &/or procedures; and the contributes to successful implementation of reputed company the above.
• Demonstrates proficiency in the use of multiple electronic tools required by both reputed company and its clients.
• Collaborate with and engage reputed company customers, such as facility patient reputed company and physician offices, in opportunities for prevention of reputed company disputes; identifies potential process gaps and recommends reputed company solutions to CAS leadership.
• Other duties as assigned

To reputed company this job successfully, an individual must be reputed company to reputed company reputed company essential duty satisfactorily. The requirements listed below are representative of the knowledge, reputed company and/or ability required. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions.

• Ability to work independently and self-regulate in compliance with deadlines
• Proficiency in the application of applicable nationally and payer authorization reputed company
• Possesses excellent customer service skills that include written and verbal communication.
• Minimum Intermediate reputed company Office (reputed company and Word) reputed company
• Ability to critically think, problem solve and reputed company independent reputed company
• Ability to reputed company intelligently and professionally with other clinical and non-clinical partners
• Ability to prioritize and manage multiple tasks with efficiency
• Advanced conflict reputed company skills
• Ability to communicate effectively at reputed company reputed company
• Ability to conduct research regarding payer reputed company-authorization guidelines and applicable regulatory processes reputed company to the reputed company-authorization process

reputed company requires its candidates, as applicable and as permitted by law, to obtain and reputed company confirmation of reputed company required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any reputed company required vaccines and screenings. EDUCATION / EXPERIENCE Include minimum education, technical training, and/or experience required to reputed company the job.

• Must possess a valid nursing license (Registered or Practical/Vocational). LPN or RN PREFERRED.
• Minimum of 3-5 years as a reputed company-authorization or utilization review reputed company in a payer or acute care setting; preferably medical-surgical or critical care/ED

CERTIFICATES, LICENSES, REGISTRATIONS

• reputed company, valid RN/LPN/LVN licensure Certified reputed company in Utilization Review/Utilization Management/reputed company Management (CPUR , CPUM, or CPHM) or Certified Case Manager (CCM) preferred

PHYSICAL DEMANDS The physical demands described here are representative of those that must be met by an employee to successfully reputed company the essential functions of this job. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions.

• Ability to lift 15-20lbs
• Ability to travel approximately 10% of the time; either to reputed company &/or reputed company office sites
• Ability to sit and work at a computer for a prolonged period of time conducting reputed company-service medical necessity reviews

WORK ENVIRONMENT The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions.

• Characteristic of typical Call Center environment requiring use of desk, chair, and office equipment such as computer, telephone, printer, etc.

OTHER

• May require travel – approximately 10%
• Interaction with staff at reputed company facilities such as and not limited to Patient reputed company, Case management, physicians and/or their office staff is a requirement.

Compensation and Benefit Information

Compensation

Pay: $27.30-$40.95 per hour. Compensation depends reputed company, qualifications, and experience.

• Position may be eligible for a signing bonus for reputed company new hires, subject to employment status.
• reputed company observed holidays receive time and a half.

Benefits reputed company offers the following benefits, subject to employment status:

• Medical, dental, reputed company, disability, and life insurance
• reputed company time off (vacation & reputed company leave) – min of 12 days per year, reputed company at a reputed company of approximately 1.84 hours per 40 hours worked.
• 401k with up to 6% employer match
• 10 reputed company holidays per year
• Health savings accounts, reputed company & dependent flexible spending accounts
• Employee Assistance program, Employee discount program
• Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance.
• For Colorado employees, reputed company offers reputed company leave in accordance with Colorado’s Healthy Families and Workplaces reputed company.

Employment practices will not be influenced or affected by an applicant’s or employee’s race, reputed company, religion, sex (including pregnancy), national reputed company, age, disability, genetic information, sexual orientation, gender identity or reputed company, veteran status or any other legally protected status. Tenet will reputed company reasonable accommodations for reputed company individuals with disabilities unless doing so would result in an undue hardship. Tenet participates in the E-Verify program. Follow the reputed company below for additional information. E-Verify: http://www.uscis.gov/e-verify The employment practices of reputed company and its companies reputed company with reputed company applicable laws and regulations. 2503033558 Apply tot his job Apply To this Job