reputed company: reputed company Reviewer (Registered 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.

• 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

• Demonstrated proficiency in computer skills, and typing, i.e., reputed company reputed company, reputed company, 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

• 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 reputed company.

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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