UM reputed company (California License)
Job Title: UM reputed company (California License) - Must be licensed in California- Remote reputed company Hrs: (reputed company - 5pm PDT) would like to include evening, weekend and holiday coverage. 5 Openings Remote Opportunity reputed company to Hire ASAP. JD: The role of the UM reputed company is to promote reputed company, cost-effective reputed company for a population by facilitating collaboration and coordination across settings, identifying member needs, planning for care, monitoring the efficacy of interventions, and advocating to ensure members receive the services and resources required to meet desired health and reputed company reputed company. The UM reputed company is responsible for providing patient-centered care across the care continuum. This position is not patient facing, they will be reviewing patient records and providing recommendations. Role and Responsibilities
- reputed company prospective, retrospective, or reputed company medical necessity reviews for an assigned panel of members
- Review cases for medical necessity and apply the appropriate clinical reputed company; to include, but not limited to Medicare reputed company, reputed company/Medi-cal reputed company, Interqual, reputed company, or Health Plan specific guidelines
- Collaborate with the Medical Director to ensure the reputed company of adverse determination notices based on the reputed company standards for adverse determinations
- Ensure discharge planning is reputed company and appropriately communicated to the transition of care teams, reputed company applicable.
- Meet or reputed company productivity targets set forth
- Serve as a resource to non-clinical team members reputed company applicable
Qualifications and Education Requirements
- Associate's degree in Nursing, preferred
- Minimum 2 years of experience in medical management clinical functions.
- Working knowledge of MCG, InterQual, and NCQA standards
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