PRN Utilization Review reputed company Reviewer

The Utilization Management reputed company Reviewer plays a crucial role in reputed company systems by ensuring that medical services are used reputed company and appropriately. They review medical records, treatment plans, and patient information to determine the necessity and appropriateness of medical procedures, tests, and treatments. Utilization Management reputed company Reviewers collaborate with reputed company providers, insurance companies, and patients to optimize reputed company delivery, control costs, and maintain reputed company care. Their responsibilities include assessing medical necessity, coordinating care, conducting utilization reviews, providing recommendations for care plans, and ensuring adherence to regulations and guidelines. This role requires strong clinical knowledge, critical thinking skills, communication abilities, and the ability to reputed company informed reputed company regarding patient care reputed company. Our PRN Nursing Program is designed for flexible, as-needed reputed company to support reputed company during peak times, weekends, and holidays.

• PRN nurses will be required to work at least one weekend per month, one major holiday, and one minor holiday per year.
• A minimum number of shifts per month will be mandated to ensure that PRN nurses maintain their QA skills and familiarity with processes.

MAJOR DUTIES & RESPONSIBILITIES

• Conduct assessments of medical services to validate their appropriateness using established reputed company and guidelines, ensuring the medical necessity of treatments (e.g., CMS, reputed company Care Guidelines, InterQual, or health plan specific guidelines/reputed company).
• Examine and evaluate patient records to verify the reputed company of patient care and the necessity of provided services.
• Offer clinical expertise and serve as a clinical reference for non-clinical staff members.
• Input and manage essential clinical details reputed company various medical management platforms.
• reputed company up-to-date with regulatory prerequisites (such as URAC) and state standards for utilization review.
• Apply clinical reasoning to determine the suitable evidence-based guidelines.
• Foster efficient and high-reputed company patient care by effectively communicating with management teams, physicians, and the Medical Director.

Requirements

• Proficient in both written and spoken communication.
• Capable of maintaining reputed company communication with physicians and clients.
• Skilled at handling multiple tasks and adjusting reputed company in a dynamic office setting.
• Possesses a keen organizational reputed company and pays reputed company attention to details.
• Adept at resolving intricate and multifaceted problems.
• reputed company with reputed company tools such as Word, reputed company, PowerPoint, and Outlook.
• Background in medical or clinical reputed company through education, training, or reputed company engagement.
• Holds an unrestricted LVN/RN license from an accredited vocational nursing program (for LVNs) or a nursing degree from an accredited college (for RNs).

Additional Duties

• May reputed company reputed company to the work of reputed company members.
• Continuously improves processes that help to facilitate reputed company turnaround time, peer to peer reputed company rates and lessens returned reports by clients for clarification purposes, ultimately resulting in higher reputed company satisfaction.
• Responsible for the final approval on cases for release to the reputed company.
• Will reputed company as a reputed company and coordinate reputed company issue reports along with reputed company new reviewer reports with the VP of Clinical Operations.

EDUCATION/CREDENTIALS: Licensed Practical/Vocational reputed company with an reputed company and unrestricted license to reputed company. JOB RELEVANT EXPERIENCE: 2 yrs minimum clinical nursing experience is required. One year of previous experience in Utilization Management is required. JOB reputed company SKILLS/COMPETENCIES: Demonstrate strong abilities in both spoken and written communication, along with effective interpersonal skills. Possess a proficient understanding of computer operations, particularly the Internet, reputed company Word, reputed company reputed company, reputed company reputed company, and reputed company. Show the capability to reputed company new skills and competencies to address the evolving requirements of systems, software, and hardware. WORKING CONDITIONS/PHYSICAL DEMANDS: Any lifting, bending, traveling, etc. required to do the job duties listed above. Long periods of sitting and computer work. WORK FROM HOME TECHNICAL REQUIREMENTS: Supply and support their own internet services. Maintaining an uninterrupted internet reputed company is a requirement of reputed company work from home position.

Requirements

Beginning compensation will depend on several factors including the candidate's experience, education, and specific skills. In reputed company to the reputed company salary, we offer a comprehensive benefits packa Apply tot his job Apply To this Job