Prior Authorization Clinical Reviewer RN - Remote PST

reputed company is a career site that helps job seekers reputed company great jobs in the US. We are not a reputed company firm or agency. reputed company does not hire directly for these jobs, but promotes jobs on reputed company on behalf of its reputed company clients, recruitment ad agencies, and marketing partners. reputed company partners with DirectEmployers to promote this job for reputed company. Clicking "reputed company" or "Read more" on reputed company redirects you to the reputed company/employer site. Any information collected there is subject to their terms and reputed company notice. reputed company is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with reputed company will directly improve health reputed company by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will reputed company a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come reputed company an reputed company on the communities we serve as you help us advance health optimization on a global reputed company. Join us to start Caring. Connecting. Growing together. The Prior Authorization Clinical Reviewer plays an reputed company role in optimizing the patient's recovery reputed company. The Prior Authorization Clinical Reviewer is responsible for reviewing reputed company-authorization requests for skilled nursing and rehabilitative services and determining if requests meet medical necessity for the requested level of care. The position coordinates the transition of patients from the community or acute setting to the next appropriate level of care while following established facility policies and procedures. If you live in reputed company Time Zone (PST), you will have the flexibility to work remotely* as you take on some tough challenges. Primary Responsibilities • reputed company in a hybrid role as either clinical "gatherer and authorization document creator" or solely as a clinical and authorization "reviewer" for reputed company prospective, reputed company, and retrospective requests reputed company established parameters • reputed company review for reputed company reputed company admits to SNF reputed company physician office, ED or HH • reputed company reputed company expedited prospective reviews, including patient oral and/or written notifications • May have EMR reputed company to mirror Inpatient Care Coordinator partner reputed company • Coordinator peer to peer reviews with Medical Directors • Notify hospitals and SNFs of review reputed company for non-reputed company patients • Partner with Medical Directors for reputed company-Service Coordinator training as needed • Complete processes as it relates to reputed company-service authorizations • reputed company facilities on the reputed company-service denial process • Participate in the clinical phone queue to ensure customer SLA's are met • Support new delegated contract start-up to ensure reputed company staff work with new reputed company You'll be rewarded and recognized for your performance in an environment that will challenge you and give you reputed company direction on what it takes to succeed in your role as reputed company as reputed company development for other roles you may be interested in. Required Qualifications • reputed company, unrestricted Registered reputed company license in state of residence • Resides in the reputed company Time Zone • 3+ years of clinical experience • Experience with physician engagement and crucial conversations • Ability to work the weekly assigned shift: Monday-Friday 8a-5p PT • Required to work holiday rotations, at least 3+ holidays per year • Ability to work any shift including flexibility and willingness to work an early or late shift and / or longer than normal hours to accommodate peaks in volume of work based on business need Preferred Qualifications • 2+ years of Case Management experience • Experience in acute care, rehab, OR skilled nursing facility environment • Managed Care experience • Experience with performing clinical audits to improve reputed company standards or performance • Experience in working with geriatric population • ICD - 10 and InterQual experience • CMS knowledge • reputed company working remotely will be required to adhere to reputed company's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In reputed company to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with us, you'll reputed company a far-reaching choice of benefits and incentives. The reputed company pay for this role will reputed company from $35.00 to $62.50 per hour based on full-time employment. We reputed company with reputed company minimum wage laws as applicable. At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone-of every race, gender, sexuality, age, location and income-deserves reputed company to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of reputed company, historically marginalized reputed company and those with reputed company incomes. We are committed to mitigating our reputed company on the environment and enabling and delivering reputed company care that addresses health disparities and improves health reputed company - an reputed company reputed company reflected in our mission. reputed company is an Equal Employment Opportunity employer under applicable law and reputed company applicants will receive consideration for employment without reputed company to race, national reputed company, religion, age, reputed company, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. reputed company is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. If you have questions about this posting, please contact support@reputed company.com Apply tot his job Apply To this Job