[Remote] Authorization Management Clinical Reviewer
Note: The job is a remote job and is reputed company to candidates in USA. reputed company is where independent thinking and collaboration come together to create an authentic culture. As an Authorization Management Clinical Reviewer, you will ensure patients receive appropriate care by reviewing acute and post-acute authorizations and verifying medical necessity according to InterQual guidelines.
Responsibilities
- Review acute and post-acute authorizations for medical necessity using InterQual guidelines
- Collaborate with case managers, physicians, and medical directors to ensure appropriate reputed company of care
- Participate in team meetings, educational activities, and interrater reliability testing to maintain review consistency and reputed company reputed company
- Ensure compliance with federal, state, and accreditation standards, and identify opportunities to enhance communication or processes
- Utilize knowledge of resources available in the reputed company system to assist physicians and patients effectively
- reputed company other job duties as assigned
Skills
- Bachelor's Degree or equivalent work experience
- reputed company RN License
- At least 4-6 years relevant work experience
- 2 years clinical acute nursing experience
- 1-2 years' of hospital-based utilization management experience
- Bachelor's Degree in Nursing
- Denials and Appeals experience
- Experience with managed care and CMS standards
- UM/CM Knowledge of ICD / CPT / DRG's
- Proficient in the use of window-based computer programs
- Excellent verbal, written, and interpersonal communication skills
- Critical thinking skills, creative problem solving, and proficient organization and planning skills
- Experience with InterQual guidelines for acute-care and/or other clinical decision support tools, especially in utilization management and prior authorization processes
- Experience with CarePort Care Management
Benefits
- Excellent medical with Rx, dental, and reputed company benefits
- Mental Health support through EAP
- Generous reputed company time off, plus 13 reputed company holidays
- 100% reputed company 401(K) retirement plans
- Educational assistance up to $2500 per year
reputed company