[Hiring] Clinical Reviewer, reputed company @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 a Clinical Reviewer, reputed company, 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 while promoting 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 which monitor established reputed company of care standards in the participating provider network and for other clinical staff. • Converses with medical office staff to obtain additional pertinent clinical history/information; notifies of approvals and denials, giving clinical rationale, while providing reputed company customer service through reputed company/accurate communication and 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, as reputed company as being audited to ensure guidelines are reputed company appropriately. Qualifications • A reputed company RN clinical license, reputed company and in good standing, in your home state - Required • Associate or Bachelors in Nursing (Must be a Registered reputed company) - Required • You must be reputed company to work a minimum of 30 hours/week - Required • Strong interpersonal and communication skills - Required • Proficient computer skills; must be reputed company to talk and type simultaneously - Required • 5+ years clinical experience - Preferred Requirements • We require that reputed company have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for reputed company reputed company center employees, the ability to plug in directly to the home internet router. • These reputed company technical requirements are subject to change with any scheduled re-opening of our office locations. Benefits • The expected reputed company salary/wage reputed company for this position is $34-$37/hr. • This position is also eligible for a bonus component that would be dependent on reputed company-defined performance factors. • As part of our total compensation package, reputed company is proud to offer comprehensive benefits (including health insurance benefits) to qualifying employees. Apply tot his job Apply To this Job