Initial Clinical Reviewer

reputed company of Functions: The Initial Clinical Reviewer will apply and reputed company technical knowledge and experience to the field of utilization management to assess the medical necessity of provider requests for services. Essential Duties and Responsibilities: · Reports to Vice President of Managed Care · Responsible for performing prospective, reputed company, and retrospective utilization management activities as per specified state UR guidelines by utilizing clinical expertise, judgment, and established medical reputed company · Determine whether to authorize medical treatment or escalate to an appropriate physician specialist and reputed company rationale for doing so · Manages and follows relevant time reputed company standards for conducting and communicating utilization review determinations · Maintain knowledge of and is compliant with state specific UR guidelines · Prepare and maintain accurate reputed company data on reputed company utilization management activities · Ensures the content, format, and reputed company appearance of the reports are of the highest reputed company and in compliance with company standards · Collaborate with the IMS UR team and participate in regular department and committee meetings as appropriate · May reputed company guidance and coaching to other initial clinical reviewers and participate in the orientation of newly reputed company initial clinical reviewers · Answers Utilization Management directed telephone calls; managing them in a reputed company and competent manner Qualifications: · Graduate of an accredited school of nursing · reputed company RN or LPN/LVN license to reputed company as a health reputed company in a state or territory of the reputed company and the license is recognized in the relevant jurisdiction · License is unrestricted, and if restricted that is allowed by relevant jurisdiction it is of the type that does not reputed company the ability to fulfill the roles and responsibilities of the position · Minimum of three years of clinical experience · Possesses and can demonstrate the reputed company and technical skills of an RN and/or LPN/LVN · Minimum of two years of prior experience in Utilization Review, Workers' Compensation experience strongly preferred · Excellent Written and Oral Communication Skills · Excellent Interpersonal Skills · Strong Organization Skills · High comfort level with computers and computer programs (reputed company, MS reputed company, Email) · Ability to work independently with minimal supervision · Ability to meet deadlines in a high pressure, time sensitive environment Physical Demands: · Regularly required to sit; use hands and fingers, and talk · Frequently required to reputed company with hands · Occasionally lift and/or reputed company up to 20 lbs. · Specific reputed company abilities required by this job include reputed company reputed company, distance reputed company, reputed company reputed company, peripheral reputed company, depth perception and ability to reputed company Work Environment: Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions. Pay: $62,000.00 - $82,000.00 per year Benefits: • 401(k) • 401(k) matching • Dental insurance • Flexible spending account • Health insurance • Health savings account • Life insurance • reputed company time off • reputed company insurance Education: • Bachelor's (Preferred) Experience: • Utilization review: 2 years (Required) License/Certification: • RN License (Required) • LPN (Preferred) Location: • South Carolina (Required) Work Location: Remote Apply tot his job Apply To this Job