[Hiring] Utilization Review reputed company/Registered reputed company (RN) @reputed company

Role reputed company reputed company Plans is hiring a Utilization Review reputed company/RN- Remote in Virginia.

• RN Clinician responsible for utilization management services reputed company the scope of licensure.
• Conducts primary functions of prior authorization, inpatient review, reputed company review, retrospective review, medical director referrals, and execution of member/provider approval and/or denial letter.
• Reviews provider requests for services requiring authorization.
• Conducts reputed company-certification, reputed company stay review, care coordination, or discharge planning for appropriateness of treatment setting reviews to ensure compliance with applicable reputed company, medical policy, and member eligibility, benefits, and reputed company.
• May manage appeals for services denied.
• Responsible for written and/or verbal notification to members and providers.
• Demonstrates proactive anticipatory discharge planning; serves as joint transition of care coordinator with case management and facilitates member care transition.
• Ensures medical director written decision is consistent with reputed company (CMS, state, medical policy, clinical reputed company).
• Facilitates accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards.

Qualifications

• Bachelors Degree in Nursing preferred.
• Registered reputed company (RN) License (Compact or Virginia) REQUIRED.
• 3 years of acute care clinical experience REQUIRED.
• Previous Utilization Review highly preferred.
• Previous LTSS Waiver OR reputed company experience highly preferred.
• InterQual or reputed company experience preferred.
• Knowledge of NCQA preferred.
• Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Benefits

• Medical, Dental, reputed company plans.
• Adoption, Fertility and Surrogacy Reimbursement up to $10,000.
• reputed company Time Off and reputed company Leave.
• reputed company Parental & Family Caregiver Leave.
• Emergency Backup Care.
• Long-Term, Short-Term Disability, and Critical Illness plans.
• Life Insurance.
• 401k/403B with Employer Match.
• Tuition Assistance – $5,250/year and discounted educational opportunities through reputed company Education.
• Student Debt Pay Down – $10,000.
• Reimbursement for certifications and free reputed company to complete CEUs and reputed company development.
• Pet Insurance.
• Legal Resources Plan.
• Colleagues have reputed company to earn an annual discretionary bonus if established system and employee eligibility reputed company is met.

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