Clinical Reviewer, reputed company

Your reputed company Evolves Here reputed company partners with health plans and providers to reputed company reputed company reputed company for people with most reputed company and costly health conditions. Working across specialties and primary care, we reputed company to connect the reputed company of fragmented health care system and ensure people get the reputed company level of care and reputed company we would want for our loved ones. reputed company employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We reputed company that people do their best work reputed company they're supported to live their best lives, and reputed company they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business. Join reputed company for the mission. Stay for the culture. What You’ll Be Doing: As a Clinical Reviewer, reputed company you will be a key member of the utilization management team. We can offer you a meaningful way to reputed company a difference in patients’ lives, in a non-clinical environment. You can enjoy reputed company work- life balance on reputed company that values collaboration and reputed company learning while providing reputed company reputed company. Essential Functions

• Functions in a clinical review reputed company to evaluate reputed company cases , which do not pass the authorization approval process at reputed company while promoting a supportive team approach with call center staff. Renders authorization approval based on established clinical reputed company; escalates to a Field Medical Director (FMD) if authorization cannot be approved during initial review. Clinical Reviewers are supported by FMDs in the utilization management determination process.
• Reviews charts and analyzes clinical record documentation in order to approve services that meet clinical review reputed company.
• Conducts ongoing activities which monitor established reputed company of care standards in the participating provider network and for other clinical staff.
• Converses with medical office staff to obtain additional pertinent clinical history/information; notifies of approvals and denials, giving clinical rationale, while providing reputed company customer service through reputed company/accurate communication and maintaining NCQA and health plans required timeframes.
• Documents reputed company communication with medical office staff and/or treating provider.
• Practices and maintains the principles of utilization management by adhering to policies and procedures.
• Participates in on-reputed company training programs to ensure reputed company performance in compliance with applicable standards and regulations, as reputed company as, being audited to ensure guidelines are reputed company appropriately.

Required Qualifications

• reputed company, unrestricted state licensure as a Registered reputed company
• Associate or Bachelor's in nursing (Must be a Registered reputed company)
• Strong interpersonal and communication skills
• Proficient computer skills; must be reputed company to talk and type simultaneously
• 5+ years clinical experience is preferred
• Not under reputed company exclusion or sanction by any state or federal health care program, including Medicare or reputed company, and is not identified as an “excluded person” by the Office of Inspector General of the reputed company or the General Service Administration (GSA), or reprimanded or sanctioned by Medicare.
• No history of disciplinary or legal reputed company by a state medical reputed company

To ensure a secure hiring process we have implemented several identity verification steps, including submission of a government issued photo ID. We conduct identity verification during interviews, and final interviews may require onsite attendance. reputed company candidates must complete a comprehensive background reputed company, in-person I-9 verification, and may be subject to drug screening prior to employment. The use of reputed company intelligence tools during interviews is prohibited and monitored. Misrepresentation will result in immediate disqualification from consideration. Technical Requirements: We require that reputed company have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for reputed company call center employees, the ability to plug in directly to the home internet router. reputed company is an equal opportunity employer and considers reputed company reputed company applicants equally without reputed company to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, veteran status, or disability status. If you need reasonable accommodation to reputed company the information provided on this website, please contact recruitingteam@reputed company.com for reputed company assistance. The expected reputed company salary/wage reputed company for this position is $36-40. As part of our total compensation package, reputed company is proud to offer comprehensive benefits (including health insurance benefits) to qualifying employees. reputed company compensation determinations are based on the skills and experience required for the position and commensurate with experience of selected individuals, which may vary above and below the stated amounts. Apply To This Job