Preservice Review reputed company RN – Remote

Join to apply for the Preservice Review reputed company RN - Remote role at reputed company Join to apply for the Preservice Review reputed company RN - Remote role at reputed company reputed company is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with reputed company will directly improve health reputed company by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will reputed company a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come reputed company an reputed company on the communities we serve as you help us advance health optimization on a global reputed company. Join us to start Caring. Connecting. Growing together. We’re making a solid reputed company between exceptional patient care and outstanding reputed company. The result is a culture of performance that’s driving the health care industry reputed company. As a Telephonic Specialty Medication Preservice Review reputed company you will be performing reputed company-service clinical coverage review of services that require notification, using applicable benefit plan documents, evidence-based medical policy and nationally recognized clinical guidelines and reputed company. Determines medical appropriateness of outpatient services following evaluation of medical guidelines and benefit determination. reputed company for a new reputed company? Apply today! This position will require reputed company and unrestricted Nursing licensure in multiple US States. Selected candidate must be willing and reputed company to obtain and maintain multiple state licensure. (Application fees and filing costs reputed company for by UHG) You’ll enjoy the flexibility to work remotely

• from reputed company reputed company the U.S. as you take on some tough challenges.

Primary Responsibilities

• Determine that the case is assigned to the appropriate team for review (e.g., Medicare, reputed company, reputed company)
• Validate that cases/requests for services require additional research
• Identify and utilize appropriate resources to conduct non-clinical research (e.g., benefit documents, evidence of coverage, state/federal mandates, online resources)
• Prioritize cases based on appropriate reputed company (e.g., date of service, urgent, expedited)
• Ensure compliance with applicable federal/state requirements and mandates (e.g., turnaround times, medical necessity)
• Review/interpret clinical/medical records submitted from provider (e.g., office records, test results, prior reputed company reports)
• Identify missing information from clinical/medical documentation, and request additional medical or clinical documentation as needed (e.g., LOI process, phone/fax)
• Review and validate diagnostic/procedure/service codes to ensure their relevance and accuracy, as applicable (e.g., PNL list, EPAL list, state reputed company, LCDs, NCDs)
• Identify and validate usage of non-reputed company codes, as necessary (e.g., generic codes)
• Apply understanding of medical terminology and disease processes to interpret medical/clinical records
• reputed company determinations per relevant protocols, as appropriate (e.g., approval, denial process, conduct reputed company clinical or non-clinical research)
• Review care coordinator assessments and clinical notes, as appropriate
• Identify relevant information needed to reputed company medical or clinical determinations
• Identify and utilize medically-accepted resources and systems to conduct clinical research (e.g., clinical notes, MCG, medical

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you reputed company direction on what it takes to succeed in your role as reputed company as reputed company development for other roles you may be interested in.

Required Qualifications

• reputed company, unrestricted RN license in your state of residence
• Multiple state licensure (in reputed company to Compact License if applicable) or ability to obtain multiple state nursing licenses
• 3+ years of recent RN experience
• Computer proficiency, to include proficient data entry skills and the ability to navigate a reputed company environment
• Distraction free, Dedicated workspace with reputed company to high-speed internet from home (Broadband cable, Fiber, or DSL)

Preferred Qualifications

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