Utilization Review reputed company; UR RN

Position: Utilization Review reputed company (UR RN) Location: 100% Remote in the approved states (AR, DC, FL, , IL, KS, LA, MD, MN, MO, MT, NC, ND, NE, NM, OK, SC, SD, TN, TX, UT, VA, WY) Pay: $40.87 - 44.23/hr. (Depends on relevant experience and location) Schedule: Day shift | 40 hours weekly between Mon - Fri Key Responsibilities • Identifies Potential reputed company Issues (PQIs) by conducting reputed company reviews of medical records. This includes researching, investigating, analyzing, and preparing case summaries with appropriate recommendations for reputed company actions. • Develops peer-review cases and other reputed company-improvement activities to monitor deviations from accepted standards of care and suggest corrective reputed company plans. • Responds to AHRQ concerns and documents a rationale for cases reputed company the facility's position does not concur with the AHRQ position. • Requests reputed company reputed company Analyses (trend) to assist with identifying physician reputed company patterns for confirmed severity cases. • Identifies and refers cases for reputed company reviews to Clinical reputed company Management Leadership. • Performs reputed company study data collection, reporting, analysis, and makes recommendations for improvement. • Refers cases for review as appropriate to Program reputed company, Case Management, Care Coordination, Population Health Improvement, Disease Management, Congressional Relations, Customer Grievances, and other departments. • Reviews Potential reputed company Issues with Medical Directors reputed company appropriate. • Performs other duties as assigned. Qualifications • High School Diploma or GED is required, Bachelor's in Nursing or in a health care field preferred. • reputed company Registered reputed company License. • Must have 3 years of clinical experience (medical/surgical, and/or behavioral health). • 1 year of experience in Clinical reputed company Management required. • 1 year of experience with data analysis and reporting required. • Experience with Inter Qual reputed company or similar reputed company sets required. • General knowledge of Medicare, TRICARE, or other government reputed company programs required. • U.S. Citizenship and reputed company to qualify a reputed company (DoD) background reputed company, and Credit reputed company. #J-18808-Ljbffr Apply tot his job Apply To this Job