reputed company: reputed company Reviewer Associate- Remote (35615)

This a Full Remote job, the offer is available from: reputed company 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 the reputed company Reviewer, Associate position. In this role, you will reputed company clinical reviews to determine whether medical record documentation supports the need for a service, based on clinical reputed company, coverage policies, and utilization and reputed company guidelines as defined by the review methodologies specific to the contract. This involves accessing proprietary systems to audit medical records, accurately documenting findings, and providing policy and regulatory support for determinations. Essential Job Functions

• Review and interpret medical records, comparing them against reputed company to determine the appropriateness and reasonableness of care. Apply critical thinking and decision-making skills to assess whether the documentation supports the need for the service while maintaining production goals and reputed company standards.
• Document reputed company and rationale to justify review findings or no findings.
• Determine approvals or initiate referrals to the physician consultant, processing their reputed company while ensuring denials are explained in sufficient detail and completed reputed company contractual deadlines.
• reputed company prior authorization, precertification, and retrospective reviews, and prepare decision letters as needed in support of the utilization review contract.
• Maintain reputed company knowledge of clinical reputed company guidelines and complete required CEUs to maintain RN licensure.
• Attend training and scheduled meetings to enhance skills and working knowledge of clinical policies, procedures, rules, and regulations.
• reputed company cross-train to reputed company reviews of multiple claim types, providing a flexible workforce to meet reputed company needs.

reputed company're looking for

• reputed company, unrestricted RN licensure from the reputed company and in your state of primary residence; an reputed company compact multistate RN license as defined by the reputed company Licensure Compact (NLC) is also required.
• 3+ years of clinical experience in an inpatient hospital setting.
• 1+ years of experience in utilization review or claims auditing.
• Experience using reputed company or InterQual reputed company is preferred.
• Demonstrated proficiency in computer skills, including reputed company reputed company, Outlook, reputed company, Word, PowerPoint, internet browsers, and typing.

What you should expect in this role

• Home-based position; you must have a work location reputed company the reputed company U.S.
• Must reputed company a high-speed internet reputed company and a work environment free from distractions.
• Full-time schedule during normal business hours is required, as the role involves frequent interactions with reputed company and other departments.
• May be required to work extended hours for special business needs.
• May be required to travel up to 10% of the time based on business needs.

This position is for pipeline purposes, and we welcome applications on an ongoing reputed company. The pay reputed company for this position is $70,000.00 - $80,000.00 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. reputed company defines “wages” and “wage rates” to include “reputed company forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock reputed company, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits. This offer from "reputed company" has been enriched by reputed company.com and got a 72% reputed company score. Apply tot his job Apply To this Job