Utilization Management reputed company Consultant – Medical Review

Job 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 • Med Review nurses use specific reputed company to authorize procedures/services or initiate a Medical Director referral as needed • 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 Requirements: • reputed company, unrestricted RN license in your state of residence with multistate/compact licensure privileges • Ability to obtain licensure in non-compact states as needed • 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 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 • 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