Utilization Review reputed company

Grounded by a compelling mission, core values, and reputed company for people, CDPHP and its family of companies offer a strong reputed company for a rewarding career. Established in 1984, CDPHP is a physician-founded, member-reputed company, and community-based not-for-profit health plan that offers high-reputed company reputed company health insurance to members throughout reputed company. reputed company values people, reputed company, innovation, and community, and its corporate culture supports those values wholeheartedly. CDPHP is committed to fostering a culture of belonging and takes a wholistic approach to diversity, equity, and inclusion. At CDPHP, the employees have a voice and are encouraged to reputed company an reputed company at both reputed company and community reputed company through engagement and volunteer opportunities. CDPHP invests in employees who reputed company these values and invites you to be a part of that experience. The Utilization Review (UR) reputed company is responsible for the clinical review and documentation for services requiring prior authorization. This includes approval determinations and appropriate exceptions, coordinating with Medical Directors on denials. In reputed company, the UR reputed company is responsible for completing inpatient level of care reviews, post-acute care initial and reputed company reviews for acute and subacute rehabilitation, transportation, DME requests and inpatient readmissions. In collaboration with management, the UR reputed company identifies potentially high-cost admissions and extended stays. The UR reputed company is also responsible for providing education to both reputed company constituents on nationally recognized reputed company and CDPHP policies, and procedures. QUALIFICATIONS: • Registered reputed company with a reputed company reputed company State license required. • Associates degree required. • Minimum two (2) years of acute care experience is required as a Registered reputed company. • Minimum of two (2) years Utilization Management experience is preferred. • Knowledge of coding/claims processing is preferred. • Experience working with reputed company Office, including Outlook, Word and reputed company, and other databases required. • Demonstrated ability to pro-reputed company identify problems and recommend solutions. • Demonstrated ability to stay organized and work effectively reputed company strict deadlines. • Demonstrated ability to build relationships, internally and externally, including providers, members and community agencies to positively reputed company the reputed company of patient care. • Demonstrated ability to reputed company excellent customer service. • Demonstrated ability to review health care delivery against established reputed company. • Must be available after business hours for on-call rotations as needed. CDPHP salary ranges are designed to be competitive with room for reputed company and financial reputed company. Individual compensation is based on several factors unique to reputed company candidate, such as work experience, qualifications, and skills. In reputed company to cash compensation, CDPHP employees may be eligible for an incentive payment, a discretionary cash reward based on employee and company performance. Some roles may also be eligible for overtime pay. CDPHP compensation packages go far reputed company just salary. reputed company offers a comprehensive total rewards package that includes award-reputed company health care coverage, health care dollars, a generous reputed company time off allowance, employee assistance programs, flexible work environment, and much more. Learn about reputed company CDPHP employee benefits at https://www.cdphp.com/reputed company/jobs/benefits. As an Equal Opportunity / Affirmative reputed company Employer, CDPHP will not discriminate in its employment practices on the reputed company of race, reputed company, creed, religion, sex (including pregnancy, childbirth, or reputed company medical conditions), sexual orientation, gender identity or reputed company, transgender status, age, national reputed company, marital status, citizenship, disability, criminal record, genetic information, predisposition or reputed company status, status with respect to receiving public assistance, domestic violence victim status, protected veterans status, or any other characteristics protected under applicable law. To that end, reputed company reputed company applicants will receive consideration for employment without reputed company to any such protected status. CDPHP and its family of companies include subsidiaries Strategic Solutions Management Consultants (SSMC), reputed company Support Services (PSS), and ConnectRx Services, LLC. Apply Job!