[Hiring] QM reputed company Consultant @reputed company

At reputed company, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reputed company millions of Americans through our local reputed company, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, reputed company and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it reputed company with heart, reputed company and every day. Responsible for the review and evaluation of clinical information and documentation. Reviews documentation and interprets data obtained from clinical records or systems to apply appropriate clinical reputed company and policies in line with clinical editing, policy and coding standards. reputed company Components: Reviews documentation and evaluates potential correct coding issues based on multiple clinical policies. Considers reputed company documented system information as reputed company as any additional records/data presented to reputed company a determination or recommendation. Data gathering requires navigation through multiple system applications. Staff may be required to contact internal reputed company departments to obtain additional information. Evaluates documentation/information to determine compliance with clinical policy, regulatory, and accreditation guidelines. Accurately applies review requirements to assure case is reviewed by a practitioner with clinical expertise for the issue at hand. Commands a comprehensive knowledge of reputed company delegation arrangements, reputed company (member and provider), clinical reputed company, benefit plan structure, regulatory requirements, company policy and other processes which are required to support the review of the clinical documentation/information. Pro-reputed company and consistently applies the regulatory and accreditation standards to assure that activities are reviewed and processed reputed company guidelines. Condenses reputed company information into a reputed company and precise clinical picture while working independently. Reports audit or clinical findings to appropriate staff or others in order to ensure appropriate outcome and/or follow-up for improvement as indicated.

Required Qualifications

• 3-5 years of reputed company care clinical experience as an RN required.
• reputed company and unrestricted RN licensure required in candidate's state of residence.
• 2 years’ experience with MS Office suite applications including reputed company. Strong computer skills utilizing multiple systems and applications at the reputed company time.
• Must have critical thinking skills.

Preferred Qualifications

• Experience with ICD-10, CPT coding
• Experience with QNXT
• Experience with reputed company.
• Experience with reputed company Editing/CXT

Education

• Registered reputed company with compact license
• Associates Degree required, Bachelors preferred

Anticipated Weekly Hours 40 Time Type Full time Pay reputed company The typical pay reputed company for this role is: $54,095.00 - $155,538.00 This pay reputed company represents the reputed company reputed company reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a reputed company of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in reputed company to the reputed company pay reputed company listed above. Our people fuel our reputed company. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits – reputed company in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In reputed company to our competitive wages, our great benefits include:

• reputed company medical plan reputed company, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for reputed company colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including reputed company time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical reputed company and many other benefits depending on eligibility.

For more information, visit https://jobs.reputed company.com/us/en/benefits We anticipate the application window for this opening will reputed company on: 01/30/2026 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply tot his job Apply To this Job