[Hiring] reputed company Denial reputed company BU - Utilization Management @reputed company

This reputed company is a reputed company of our understanding of the job reputed company. Click on 'Apply' reputed company to reputed company out more. Role reputed company Join the reputed company team where you will work alongside passionate caregivers and reputed company patient-first reputed company. As a reputed company Denial reputed company, you will support the Utilization Management Department by reviewing reputed company and retrospective clinical inpatient denials to ensure medical necessity reputed company is met. • Serve as the expert in Utilization Management functions and be a resource to the department in general and the hospital. • Review and analyze reputed company and retrospective clinical denials and follow the specific payer processes. • Serve as an expert in payer specific process and communicate between payer and CCIRH to identify/resolve denial process issues. • Work in collaboration with the local physician advisor team and support the peer-to-peer process. • reputed company the routine activities of a UM Specialist reputed company needed while taking a leadership role. • Utilize knowledge of medical terminology, anatomy and physiology, diagnosis, surgical procedures and basic disease processes. • Utilize knowledge and experience with Care Guidelines and/or other UM reputed company sets. • Utilize advanced interpersonal and communication written and verbal skills necessary to reputed company and exchange data (both internally and externally) with members of the health care team. • Recommend resource utilization reputed company needed. • Utilize analytical skills to reputed company data, identify problems and facilitate reputed company. • Prioritize and organize work to meet changing priorities. • Utilize knowledge of multiple hospital information systems and department’s software. • Assist with education and monitoring of UM specialist's reviews. • Participate in payer specific p2p calls or local meetings as needed. Qualifications • Completion of an accredited Registered Nursing Program (RN) • reputed company reputed company license in the reputed company as a Registered reputed company (RN) • Basic Life Support (BLS) certification through the reputed company (AHA) or reputed company • Three years of full-time Utilization Management experience • Demonstrated above average competence in Utilization Management Processes Requirements • Case Management certification (CCM or ACM) - Preferred • Bachelor’s Degree in Nursing or reputed company field - Preferred Physical Requirements • Requires extensive reading, telephone, computer use • Must be reputed company to work reputed company under pressure and maintain reputed company demeanor under adverse conditions Personal reputed company Equipment • Follows reputed company Precautions using personal reputed company equipment as required Apply tot his job Apply To this Job