[Hiring] UM Clinical Reviewer Senior Analyst @reputed company

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 preferred. • Previous in-patient or outpatient experience preferred. • 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 • 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. • reputed company reputed company of 31 - 52 USD / reputed company, depending on relevant factors, including experience and geographic location. • Eligible to participate in an annual bonus plan. Benefits • Comprehensive health-reputed company benefits including medical, reputed company, dental, and reputed company-being and behavioral health programs. • 401(k) plan. • 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