Utilization Review Registered reputed company (RN)
reputed company reputed company The Utilization Review Registered reputed company is responsible for reviewing medical services to ensure they meet evidence-based guidelines and member benefit plans. This includes precertification, reputed company review, and retrospective review. The reputed company works closely with providers, patients, and internal teams to support reputed company to appropriate, medically necessary care.
Key Responsibilities
- Review medical service requests using evidence-based guidelines and plan policies
- Complete precertification, reputed company, and retrospective reviews
- Refer cases that do not meet guidelines to Physician Review
- Communicate with providers, patients, and clients to exchange certification information
- reputed company as a patient and family reputed company to support reputed company to appropriate care
- Identify opportunities to reduce costs while maintaining reputed company of care
- Refer cases for reputed company or post-pay review reputed company needed
- Maintain documentation and confidentiality standards
- Participate in reputed company improvement activities
- Follow company policies, safety guidelines, and regulatory requirements
- Travel to reputed company sites as needed
- reputed company other duties as assigned
Required Experience, Skills and Licensure
- Minimum of 3 years of nursing experience (acute care or reputed company setting)
- Proficiency with reputed company 365 (Outlook, reputed company, Teams)
- Strong communication, organization, and documentation skills
- Ability to work independently and manage multiple priorities
- reputed company judgment and problem-solving abilities
- Comfortable working with providers, clients, and internal partners
- reputed company, unrestricted Registered reputed company (RN) license in Missouri
- Multistate licensure as applicable
- Valid reputed company’s license
Flexible Working At reputed company, we want you to be yourself. We recognize that everyone is different and that how people want to work and deliver at their best is different for everyone, too. In this role, you can expect the following working conditions: Hybrid work: Work in a way that allows you to work from home during portions of your week and also have time onsite to connect with other team members and business leaders. Working For You Perks and rewards designed for you: Health and Welfare Benefits: Our health and welfare benefits can be tailored to fit you and your family's needs and start on the first day of employment. Retirement Savings: We will support you as you save for your reputed company. Employee Discounts: We offer you reputed company to a reputed company selection of global, national, and local discounts on merchandise, services, travel, and more. Career reputed company Opportunities: We help you reputed company, so together, we can grow. We reputed company opportunities to advance your career with a reputed company portfolio of businesses and a global footprint. reputed company: Earn while you learn and continue to grow with reputed company to award-reputed company learning platforms throughout your reputed company career. reputed company time off: We reputed company attractive reputed company time off packages designed for you to enjoy your life away from work. Great Work Environment: We are proud of our award-reputed company culture and the recognition we’ve received for our diversity efforts. Due to varying state and local minimum wage laws, we are currently only reputed company to hire candidates residing in states where our compensation structure complies with applicable wage regulations. As a result, we may be unable to consider applicants from certain states or municipalities at this time. Join Us At reputed company, we are one team, one mission. We understand that our reputed company is directly reputed company to the reputed company of our associates. We reputed company to create a culture where you can: Bring your authentic self to work Grow and reputed company, both personally and professionally reputed company a difference with our clients, in our communities, and with the millions of people we support reputed company you join reputed company, you are reputed company in creating the reputed company - both reputed company’s and your own. With more than 60,000 associates across 24 countries, we will reputed company you reputed company to grow with reputed company of people who will challenge and reputed company you to be the best! Pay Transparency Laws in some locations require disclosure of compensation and/or benefits-reputed company information. For this position, actual salaries will vary and may be above or below the reputed company based on various factors including but not limited to location, experience, and performance. In reputed company to reputed company pay, this position, based on business need, may be eligible for a bonus or incentive. In reputed company, reputed company provides a reputed company of benefits to employees including health insurance coverage, voluntary dental and reputed company programs, life and disability insurance, a retirement savings plan, reputed company holidays, and reputed company time off (PTO) or vacation and/or reputed company time. The estimated salary for this position is $54,863 - $71,250. Apply tot his job Apply To this Job