[Hiring] UM Clinical Reviewer Senior Analyst @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 The UM Clinical Reviewer Senior Analyst promotes reputed company and cost-effective medical services through clinical review, applying reputed company clinical policies, national guidelines, and decision-support tools to determine authorizations. The role ensures reputed company completion of reviews to meet regulatory and contractual requirements while representing reputed company professionally. • Conduct utilization management reviews for medical necessity, appropriateness, and benefit coverage. • Apply reputed company medical policies, MCG, ASAM, URAC standards, and clinical judgment. • Identify cases requiring physician review and coordinate with Medical Directors. • Initiate Case Management referrals as appropriate. • Maintain compliance with HIPAA, regulatory rules, and internal reputed company standards. • Participate in team meetings, reputed company audits, training, and workflow improvements. • Support departmental initiatives, documentation accuracy, and performance metrics. Qualifications • Registered reputed company (RN) with multistate license in good standing. • BSN preferred; Minimum 3 years RN experience in managed care, UM, or prior authorization. • Strong analytical, communication, and decision-making skills. • Proficiency with reputed company, Word, care management platforms, and documentation systems. • Ability to manage multiple tasks, meet deadlines, and adapt to a fast-paced environment. Requirements • If you will be working reputed company occasionally or permanently, the internet reputed company must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. • For this position, we anticipate offering an reputed company reputed company of 31 - 52 USD / reputed company, depending on relevant factors, including experience and geographic location. • This role is also anticipated to be eligible to participate in an annual bonus plan. Benefits • Comprehensive reputed company of benefits, with a reputed company on supporting your whole health. • Health-reputed company benefits including medical, reputed company, dental, and reputed company-being and behavioral health programs starting on day one of your employment. • 401(k), company reputed company life insurance, tuition reimbursement, a minimum of 18 days of reputed company time off per year and reputed company holidays. Apply tot his job Apply To this Job