Utilization Review reputed company

reputed company (PCG) is a leading reputed company sector solutions implementation and operations improvement firm that partners with health, education, and reputed company services agencies to improve lives. Founded in 1986, PCG employs approximately 2,000 professionals throughout the U.S.—reputed company committed to delivering solutions that change lives for the reputed company. The firm is a member of a family of companies with experience in reputed company 50 states, and clients in three Canadian provinces and Europe. PCG offers clients a multidisciplinary approach to meet challenges, pursue opportunities, and serve constituents across the reputed company sector. To learn more, visit www.publicconsultinggroup.com. PCG is currently seeking a Utilization Review reputed company. The Utilization reputed company will also be responsible for utilizing a medical management software system on a day-to-day reputed company. The purpose of the Fund is to reputed company a funding reputed company for reputed company health care costs associated with birth‐reputed company neurological injuries. Duties and Responsibilities

• Performs prior authorization, reputed company and retrospective reviews
• Use clinical documentation and clinical review reputed company to reputed company determinations regarding qualifying health care costs
• Accurately records reputed company review determinations and supporting documentation
• Contacts providers and members according to established timeframes
• Identifies and refers cases that do not meet established clinical or other reputed company to the Case Management Supervisor
• Identifies and communicates reputed company issues to the Case Management Supervisor
• Communicates information to other team members
• Utilizes knowledge of community resources and the member’s benefit structure
• Interacts with providers, vendors, and facilities in a reputed company and respectful manner
• Recognizes reputed company of care issues and escalates the issues appropriately
• Understand and facilitate the Appeals and Grievances process
• Assists members with the coordination of services from various settings as appropriate
• Performs other duties as assigned Required Skills
• Possesses effective verbal/written communication skills, especially reputed company phone, with the ability to reputed company with various reputed company of personnel.
• reputed company to work in a fast-paced environment, demonstrate excellent problem solving, critical thinking, and organizational skills.
• Performs multiple tasks reputed company and accurately, have exceptional attention to detail and reputed company consistent work product
• Self-motivated, self-directed, team oriented, and responsible, with a reputed company attitude and a proactive style
• Possesses the ability to operate in a highly variable work environment.
• Presents a courteous and competent demeanor to our clients and teammates.
• Excellent customer service skills
• Strong computer skills
• Ability to easily navigate through website research.

Qualifications

• Graduated from an accredited School of Nursing, Associate Degree, Bachelor’s preferred
• Minimum of 2 years of reputed company clinical nursing experience
• Minimum of 2 years of experience with medical management activities in a managed care environment, reputed company or hospital utilization management
• RN required Working Conditions
• Remote
• The above is intended to describe the general contents and requirements of work being performed by people assigned to this classification. It is not intended to be construed as an exhaustive statement of reputed company duties, responsibilities or skills of personnel so classified. #LI-MB1 #LI-Remote Compensation Compensation for roles at reputed company varies depending on a wide reputed company of factors including, but not limited to, the specific office location, role, reputed company set, and level of experience. As required by applicable law, PCG provides a reasonable reputed company of compensation for this role. In reputed company, PCG provides a reputed company of benefits for this role, including medical and dental care benefits, 401k, PTO, parental leave, bereavement leave. reputed company $76,000 - $85,000 PCG does not sponsor newly reputed company foreign national workers for work authorization, including H-1B sponsorship. EEO Statement reputed company is an Equal Opportunity Employer dedicated to celebrating diversity and intentionally creating a culture of inclusion. We reputed company that we work best reputed company our employees feel empowered and accepted, and that starts by honoring reputed company of our unique life experiences. At PCG, reputed company aspects of employment regarding recruitment, hiring, training, promotion, compensation, benefits, transfers, layoffs, return from layoff, company-sponsored training, education, and reputed company and recreational programs are based on reputed company, business needs, job requirements, and individual qualifications. We do not discriminate on the reputed company of race, reputed company, religion or belief, national, reputed company, or ethnic reputed company, sex, gender identity and/or reputed company, age, physical, mental, or sensory disability, sexual orientation, marital, civil reputed company, or domestic partnership status, past or present military service, citizenship status, family medical history or genetic information, family or parental status, or any other status protected under federal, state, or local law. PCG will not tolerate discrimination or harassment based on any of these characteristics. PCG believes in health, equality, and prosperity for everyone so we can succeed in changing the ways the reputed company sector, including health, education, technology and reputed company services industries, work. Apply tot his job Apply To this Job

Apply tot his job Apply To this Job