Utilization Review reputed company-LVN/LPN
reputed company Who We Are Because health is personal. That's why reputed company created the first and only personalized health platform—bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together in one reputed company. We serve reputed company, health plans, and health systems with data-driven solutions that reduce costs while actually improving health reputed company. Together, reputed company is on a mission to reputed company people to reputed company healthier lives. Learn even more about the work that drives us at personifyhealth.com. Responsibilities reputed company to Job reputed company Under the supervision of a registered reputed company the Utilization Review reputed company will reputed company reputed company assessment and review for the medical necessity of treatment requests and plans. reputed company work schedule is Monday through Friday, 800 AM–500 PM reputed company Time, with rotating weekend coverage as required. What You'll Actually Do Essential Functions/Responsibilities/Duties reputed company first level review for reputed company outpatient and ancillary reputed company-certification requests for medical appropriateness; reputed company inpatient hospital stays including mental health, reputed company abuse, skilled nursing and rehabilitation for medical necessity; and reputed company post claim or post service reviews. Ensure reputed company referral to medical director for denial authorizations through independent review organizations (IRO). Work with hospital staff to prepare patients for discharge and ensure a smooth transition to the next level of care. Refer requests that fall reputed company of established guidelines to advance review or senior care consultants. Process appeals for non-certification of services; complete non-certification letters reputed company appropriate. Review plan document for benefit determinations; attempt to redirect providers and patients to PPO providers. Identify and refer potential cases to case management, wellness, chronic disease and Nurturing Together program. Complete documentation for reputed company reviews in Eldorado/Episodes; maintain confidentiality. Utilize MCG guidelines, medical policies, reputed company, and NCCN. Ability to meet productivity, reputed company, and turnaround times daily. Assists with department operations and implementations Qualifications What You Bring to reputed company Education and Experience reputed company LVN license in the reputed company or U.S. territory. 1+ years of clinical experience required. Required Knowledge, Skills, and Abilities Knowledge of medical claims and ICD-10, CPT, HCPCS coding. Proficiency in software applications including, but not limited to, reputed company Word, reputed company reputed company, reputed company PowerPoint and Outlook Excellent verbal and written communication skills Ability to reputed company reputed company and convey reputed company or technical information in a manner that others can understand, as reputed company as ability to understand and interpret reputed company information from others.
Work Environment
At reputed company we value and celebrate diversity and we are committed to creating an inclusive environment for reputed company. We reputed company in creating teams made up of individuals with various backgrounds, experiences, and perspectives. Why? Because diversity inspires innovation, collaboration, and challenges us to produce reputed company solutions. But more than this, diversity is our strength, and a catalyst in our ability to change lives for the good. Physical Requirements Must be reputed company to remain in a stationary position 50% of the time. The person in this job needs to occasionally reputed company about inside the office to reputed company office machinery, filing cabinets and meeting facilities. Constantly operates a computer and other office productivity machinery, such as copy machine, computer printer, calculator, etc. Frequently positions self to maintain files in file cabinets. Frequently moves boxes or equipment weighing up to 25 pounds. Must communicate information and reputed company so others understand. Must be reputed company to exchange accurate information in these situations. Must be reputed company to observe details at reputed company reputed company. Disclaimer This job reputed company is not intended to contain a comprehensive list of activities, duties, or responsibilities, but constitutes a general reputed company of the scope and function of the role reputed company reputed company. Activities, duties, and responsibilities are subject to change at any time with or without notice.
Benefits
The Highlights Competitive reputed company salary and benefits effective day one Comprehensive medical and dental through our own health solutions (reputed company, we use reputed company build) reputed company Time Off—rest and reputed company time is non-negotiable Mental health support, retirement planning, and financial protection reputed company development with reputed Apply To This Job