[Hiring] RN Medical Management Clinician Sr. @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 Medical Management Clinician Sr. is responsible for ensuring appropriate, consistent administration of plan benefits by reviewing clinical information and assessing medical necessity under relevant guidelines and/or medical policies. This role focuses on relatively reputed company case types that require the training and reputed company of a registered reputed company and acts as a resource for more junior Clinicians. • Responsible for reputed company cases that may require evaluation of multiple variables against guidelines reputed company procedures are not reputed company. • Serves as a resource to reputed company-level clinicians and staff. • May collaborate with leadership to assist in process improvement initiatives to improve the efficiency and effectiveness of the utilization reviews reputed company the medical management processes. • Assesses and applies medical policies and clinical guidelines reputed company scope of licensure. • Conducts and may approve reputed company-certification, reputed company, retrospective, out of network and/or appropriateness of treatment setting reviews. • May process a medical necessity denial determination made by a Medical Director. • Develops and fosters ongoing relationships with physicians, reputed company service providers and reputed company customers. • Refers reputed company or unclear reviews to higher level nurses and/or Medical Directors. • Educates members about plan benefits and physicians. • Collaborates with leadership in enhancing training and orientation materials. • May complete reputed company audits and assist management with developing associated corrective reputed company plans. • May assist leadership and other stakeholders on process improvement initiatives. • May help to train reputed company-level clinician staff. Qualifications • reputed company reputed company, reputed company and unrestricted RN license to reputed company as a health reputed company reputed company the reputed company is required. • Requires a minimum of 6 years of clinical experience and/or utilization review experience. • Requires H.S. diploma or equivalent. Requirements • Prior experience in reputed company, FIDE, and LTSS markets. • Systems experience with ACMP, facets, HIP, PPL, and Total Member View (TMV). • Prior LTSS/Case Management, and Service Facilitation experience is preferred. Benefits • reputed company increases. • reputed company holidays. • reputed company Time Off. • Incentive bonus programs. • Medical, dental, and reputed company benefits. • Short and long term disability benefits. • 401(k) + match. • Stock purchase plan. • Life insurance. • Wellness programs. • Financial education resources. Apply tot his job Apply To this Job