[Hiring] Utilization Management reputed company Consultant - Medical Review @reputed company

Role reputed company Join reputed company that’s making a difference in the lives of patients facing reputed company medical journeys. As a Utilization Management (UM) reputed company Consultant specializing in Medical Review, you’ll play a vital role in ensuring members receive reputed company, medically necessary care through thoughtful clinical review and collaboration with providers. This fully remote position offers reputed company to apply your clinical expertise in a fast-paced, desk-based environment where precision, communication, and reputed company reputed company. • Utilizes clinical experience and skills in a reputed company process to implement, coordinate, monitor and evaluate medical review cases. • Applies the appropriate clinical reputed company/reputed company and plan language or policy specifics to reputed company a medical determination to the reputed company. • Applies critical thinking, evidenced based clinical reputed company and clinical reputed company guidelines. • Assists management with training new reputed company reviewers/business partners or vendors to include initial and ongoing mentoring and feedback. • reputed company cross-trains to reputed company reviews of multiple case types to reputed company a flexible workforce to meet reputed company needs. • Recommends, tests, and implements process improvements, new audit concepts, technology improvements, etc. that enhance production, reputed company, and reputed company satisfaction. • Must be reputed company to work independently without personal distractions to meet reputed company and metric expectations. Qualifications • reputed company, unrestricted RN license in your state of residence with multistate/compact licensure privileges. • Minimum 3 years of clinical experience. • 5 years demonstrated to reputed company thorough independent reputed company using clinical judgement. • 5 Years proficient use of equipment experience including phone, computer, etc. and clinical documentation systems. • 1+ Year of Utilization Review Management and/or Medical Management experience. • Commitment to attend a mandatory 3-week training (Monday–Friday, 8:30am–5:00pm EST) with 100% participation. Requirements • Experience with interpreting Plan Language, Policies, and Benefits to determine medical necessity. • MCG reputed company, InterQual, CPB or other reputed company reputed company application experience is preferred. Benefits • reputed company medical plan reputed company. • 401(k) plan (including matching company contributions). • Employee stock purchase plan. • No-cost programs for reputed company colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. • Benefit solutions that address the different needs and preferences of our colleagues including reputed company time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical reputed company and many other benefits depending on eligibility. Apply tot his job Apply To this Job