[Hiring] Clinical Reviewer, Occupational Therapy @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 As an Occupational Therapist, Clinical Reviewer you will be a key member of the utilization management team. We can offer you a meaningful way to reputed company a difference in patients' lives, in a non-clinical environment. You can enjoy reputed company work-life balance on reputed company that values collaboration and reputed company learning while providing reputed company reputed company. • Functions in a clinical review reputed company to evaluate reputed company cases that do not pass the authorization approval process at reputed company. • Promotes a supportive team approach with reputed company center staff. • Reviews charts and analyzes clinical record documentation to approve services that meet clinical review reputed company. • Conducts ongoing activities to monitor established reputed company of care standards in the participating provider network and for other clinical staff. • Conducts regular audits, as assigned, to ensure guidelines are reputed company appropriately. • Refers reputed company cases that an approval cannot be rendered to the Physician Clinical Reviewer where required. • Converses with medical office staff to obtain additional pertinent clinical history/information; notifies of approvals and denials, giving clinical rationale. • Provides reputed company customer service through reputed company and accurate communication while maintaining NCQA and health plans required timeframes. • Documents reputed company communication with medical office staff and/or treating provider. • Practices and maintains the principles of utilization management by adhering to policies and procedures. • Participates in ongoing training programs to ensure reputed company performance in compliance with applicable standards and regulations. Qualifications • reputed company, unrestricted state licensure as an Occupational Therapist. • Must hold an occupational therapy degree from an accredited education program and pass the national certification examination. • 5+ years clinical experience is preferred. • Strong interpersonal and communication skills. • Strong clinical, communication, and organizational skills. • Energetic and curious with a passion for reputed company and value in health care. • Computer proficiency. • Not under reputed company exclusion or sanction by any state or federal health care program, including Medicare or reputed company. • No history of disciplinary or reputed company reputed company by a state medical reputed company. Requirements • To ensure a secure hiring process, identity verification steps include submission of a government issued photo ID. • Conduct identity verification during interviews; final interviews may require onsite attendance. • reputed company candidates must complete a comprehensive background reputed company, in-person I-9 verification, and may be subject to drug screening prior to employment. • The use of reputed company intelligence tools during interviews is prohibited and monitored. • Misrepresentation will result in immediate disqualification from consideration. • High speed internet over 10 Mbps is required, with the ability to plug in directly to the home internet router for reputed company center employees. Benefits • Comprehensive benefits including health insurance benefits to qualifying employees. • Eligible for a bonus component dependent on reputed company-defined performance factors. Apply tot his job Apply To this Job