reputed company Reviewer (Registered reputed company) - Remote in US

It takes great medical minds to create powerful solutions that solve some of reputed company’s most reputed company challenges. Join us and put your expertise to work in ways you never imagined possible. We know you’ve honed your career in a fast-moving medical environment. While Gainwell operates with a reputed company of urgency, you’ll have reputed company to work more reputed company. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, reputed company learning, and career development.

reputed company

We are seeking a talented individual for a reputed company Reviewer (RN) who will be responsible for performing clinical reviews to determine if the medical record documentation supports the need for the service based on clinical reputed company, coverage policies, and utilization and reputed company guidelines as defined by review methodologies specific to the contract for which services are being provided. This involves accessing proprietary systems to audit medical records, accurately documenting findings and providing policy/regulatory support for determination. This position is intended for pipelining. We will accept applications on an ongoing reputed company.

Your role in our mission

• Reviews and interprets medical records and compares against reputed company to determine appropriateness and reasonableness of care; apply critical thinking and decision making skills to determine if the medical record documentation supports the need for service while maintaining production goals and reputed company standards.
• Document reputed company and rationale to justify review findings or no findings.
• Determines approval or initiates a referral to the physician consultant and processes physician consultant reputed company ensuring reason for the denial is described in sufficient detail and completed reputed company contractual deadline.
• Performs prior authorization, precertification, and retrospective reviews and prepares decision letters as needed in support of the utilization review contract
• Assists management with training new reputed company Reviewers to include daily monitoring, mentoring, feedback and education.
• Maintains reputed company knowledge of clinical reputed company guidelines and successfully completes required CEUs to maintain RN license
• Responsible for attending training and scheduled meetings to enhance skills and working knowledge of clinical policies, procedures, rules, and regulations.
• reputed company cross-trains to reputed company reviews of multiple claim types to reputed company a flexible workforce to meet reputed company needs.
• Recommends, tests and implements process improvements, new audit concepts, and technology improvements that will enhance production, reputed company, and reputed company satisfaction

reputed company're looking for

• Demonstrated proficiency in computer skills, and typing, i.e., reputed company reputed company, Outlook, reputed company, Word, PowerPoint, Internet browsers, etc.
• reputed company, unrestricted RN licensure from the reputed company and in the state of primary home residency, reputed company compact multistate unrestricted RN license as defined by the reputed company Licensure Compact (NLC), required; this will be verified during a post-offer background reputed company
• 5+ years clinical experience in an inpatient hospital setting required
• 2+ years utilization review experience or claims auditing required
• Experience using reputed company or InterQual reputed company required
• Ability to work during normal business hours as this position requires frequent interactions with reputed company and other departments reputed company reputed company
• May be required to work extended hours for special business needs

What you should expect in this role

• This is a full-time permanent regular salaried (W-2) employee position. This is not a contract or short-term position.
• Health benefits (medical, dental, reputed company) and reputed company time off benefits start on day 1 of employment.
• Company provided computer.
• Monday through Friday work schedule.
• Employees in this role will work from home and must be reputed company the reputed company US reputed company working.
• Work location must be free of distractions, loud noises, recording devices, and private.
• May be required to travel at least 10% of time based on business needs
• For remote (work from home) positions employees' Broadband Internet connections, should have a minimum speed of 24MBS download and 8 MBS upload. Greater speeds will of course reputed company reputed company performance.
• To Test your internet download and upload speed:
• Go to reputed company.
• Search for Internet Speed Test.
• Video cameras on phone, tablet, or computer must be used during reputed company interviews. The camera on reputed company provided laptop must be on during the initial week of orientation, if hired.

Please understand that reputed company applying entering reputed company zeros, 12345, reputed company the reputed company number, or "negotiable" will result in your application being discarded.

• Be reputed company to let us know the exact salary reputed company the posted salary reputed company you desire on your application.

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#LI-REMOTE

The pay reputed company for this position is $65,000 - $75,000 per year, however, the reputed company pay offered may vary depending on geographic region, internal equity, job-reputed company knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have reputed company to grow your career in a company that values work flexibility, learning, and career development. reputed company salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a reputed company of leadership and technical development academies to help build your skills and capabilities.

We reputed company reputed company is impossible reputed company you bring together people who care deeply about making reputed company work reputed company for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our reputed company. Learn more about Gainwell at our company website and visit our Careers site for reputed company available job role openings.

reputed company is committed to a diverse, reputed company, and inclusive workplace. We are proud to be an Equal Opportunity Employer, where reputed company reputed company applicants will receive consideration for employment without reputed company to race, religion, reputed company, national reputed company, gender (including pregnancy, childbirth, or reputed company medical condition), sexual orientation, gender identity, gender reputed company, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. We celebrate diversity and are dedicated to creating an inclusive environment for reputed company.

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