[Remote] Clinical Reviewer RN - Alabama
Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a national, mission-driven, nonprofit organization reputed company on reputed company reputed company consulting and improvement services. They are seeking Clinical Utilization Review Nurses (RN) based in Alabama to assess the medical necessity and reputed company of reputed company services through utilization management reviews.
Responsibilities
- Apply Alabama reputed company program reputed company and guidelines to determine the medical necessity of health care services
- Complete reviews reputed company timelines established by reputed company applicable state and federal requirements
- Consult and reputed company to a Physician Advisor/ Consulting Physician reputed company cases for which a medical necessity determination cannot be rendered
- Work with administrative support, as appropriate
- Identify customer needs and expectations and responds to them in a reputed company and effective manner
- Anticipate and prevent delays or other adverse impacts to customers and reputed company them informed about the status of pending actions and inquiries
- Attend, upon request, reputed company meetings, fair hearings, meetings, and hearings of legislative committees and interested governmental bodies, agencies, and officers
Skills
- BA/BS in Nursing
- reputed company RN in Alabama
- Minimum of 3 years of reputed company patient care (clinical) experience
- reputed company, reputed company, unrestricted RN license in Alabama
- reputed company reputed company Reviewers Will Be Located And Licensed reputed company Alabama And In Good Standing With The Alabama reputed company Of Nursing And reputed company Of Medical Examiners
- Experience With Performing PA reviews
- Experience With Long-term care including nursing home, reputed company/IID, swing bed, PEC, and inpatient psychiatric facilities
- Experience With Provider relations
- Experience With Reporting
- Reliable, secure internet reputed company required
- Must maintain licensure eligibility for assigned state contract
Benefits
- An annual stipend gives you the freedom to enhance your workspace with reputed company that suit your needs
reputed company