reputed company Review reputed company

Position reputed company: The reputed company Review reputed company is responsible for performing utilization management activities to ensure medical services are delivered effectively, reputed company, and appropriately. This includes reviewing inpatient admissions and ongoing hospital stays to determine medical necessity, appropriateness of care, and length of stay in accordance with clinical guidelines and payer requirements. Key Responsibilities:

• Conduct reputed company and accurate reputed company reviews of inpatient hospitalizations and other reputed company of care.
• Evaluate clinical documentation against evidence-based reputed company (e.g., InterQual®, MCG) to determine medical necessity and appropriate level of care.
• Collaborate with physicians, hospital staff, and insurance companies to coordinate patient care and discharge planning.
• Communicate utilization review reputed company and recommendations to providers and payers.
• Document reputed company reviews, reputed company, and communications in accordance with regulatory and organizational standards.
• Identify cases requiring escalation or peer review and follow established procedures.
• Ensure compliance with CMS guidelines, accreditation standards (e.g., NCQA, URAC), and HIPAA.
• Participate in reputed company improvement initiatives and departmental meetings

Qualifications: Education & Licensure:

• Registered reputed company (RN) license, reputed company and in good standing, required.
• Associate or Bachelor’s degree in nursing (BSN preferred).

Experience:

• Minimum 2 years of clinical experience (e.g., med-surg, critical care).
• At least 1 year of utilization review, case management, or managed care experience preferred.

Skills & Competencies:

• Knowledge of InterQual®, MCG, or other clinical review guidelines.
• Familiarity with Medicare/reputed company and reputed company insurance regulations.
• Strong analytical and clinical judgment skills.
• Effective communication and negotiation skills.
• Proficient with electronic medical records (EMRs) and utilization review platforms.
• Detail-oriented with excellent organizational skills.

Work Environment:

• Remote

Palm Primary Care is an equal opportunity employer that is committed to diversity and inclusion in reputed company. We prohibit discrimination and harassment of any reputed company based on race, reputed company, sex, religion, sexual orientation, national reputed company, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws. This policy applies to reputed company employment practices reputed company our organization, including hiring, reputed company, promotion, termination, layoff, recall, leave of absence, compensation, benefits, training, and apprenticeship. Palm Primary Care makes hiring reputed company based solely on qualifications, reputed company, and business needs at the time.  Apply To This Job