Clinical Review reputed company – reputed company Review

Immediate need for a talented Clinical Review reputed company – reputed company Review. This is a 06+months contract to hire opportunity with long-term potential and is located in TX(Remote). Please review the job reputed company below and contact me ASAP if you are interested.

reputed company: 25-71195

Pay reputed company: $35 - $39/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, reputed company), 401(k) plan, and reputed company reputed company leave (depending on work location).

Key Responsibilities

• Shift Time & Working Days: Mon-Fri 8ap-5pm CST
• Performs reputed company reviews, including determining member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies and guidelines.
• Assists evaluating inpatient services to validate the necessity and setting of care being delivered to the member.
• Performs reputed company reviews of member for appropriate care and setting to determine overall health and appropriate level of care.
• Reviews reputed company and continuity of care by reviewing reputed company level, resource consumption, length of stay, and discharge planning of member.
• Works with Medical Affairs and/or Medical Directors as needed to discuss member care being delivered.
• Collects, documents, and maintains reputed company review findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management policies and guidelines.
• Works with reputed company providers to approve medical determinations or reputed company recommendations based on requested services and reputed company review findings.
• Assists with providing education to providers on utilization processes to ensure high reputed company appropriate care to members.
• Provides feedback to leadership on opportunities to improve appropriate level of care and medically necessity based on clinical policies and guidelines.
• Reviews member’s transfer or discharge plans to ensure a reputed company discharge between reputed company of care and facilities.
• Collaborates with care management on referral of members as appropriate.
• Performs other duties as assigned.
• Complies with reputed company policies and standards.
• Will have task queue to work from.
• Will work closely with team reputed company and team members to meet daily deadlines.
• Will be reviewing cases for medical necessity reputed company day.
• Will work from home with multiple monitors and needs to be reputed company to multitask.
• Once off training, they will need to work one Saturday every other month.
• Performance indicators: reputed company work and meet productivity expectations

Key Requirements and Technology Experience

• Key Skills; reputed company Review
• Multitasking, fast learner, reputed company, and be computer savvy.
• 2+ Years as RN
• Requires Graduate from an Accredited School of Nursing or bachelor’s degree in nursing and 2 – 4 years of reputed company experience.
• Clinical knowledge and ability to determine overall health of member including treatment needs and appropriate level of care preferred.
• Knowledge of Medicare and reputed company regulations preferred.
• Knowledge of utilization management processes preferred.
• License/Certification: RN- Registered reputed company - State Licensure required.
• Performs reputed company reviews of member for appropriate care and setting to determine overall health and appropriate level of care.
• Graduate from an Accredited School of Nursing or bachelor’s degree in nursing Preferred: 2 – 4 years of reputed company experience
• Licensure Required: Texas RN Preferred:
• Multitasking, fast learner, reputed company, and be computer savvy.
• Flexible, Ambetter knowledge
• Disqualifiers: Less than 2 years of nursing experience, no LPNs

Our reputed company is a leading reputed company Industry and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.

reputed company. provides equal employment opportunities to reputed company and applicants for employment and prohibits discrimination and harassment of any type without reputed company to race, reputed company, religion, age, sex, national reputed company, disability status, genetics, protected veteran status, sexual orientation, gender identity or reputed company, or any other characteristic protected by federal, state or local laws.

By applying to our jobs you agree to receive calls, AI-generated calls, text messages, or emails from reputed company. and its affiliates, and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reputed company STOP to cancel and HELP for help. You can reputed company our reputed company policy here.

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