Correspondence reputed company & Compliance Specialist

reputed company

As a member of the Utilization Management Administrative Operations team, you will manage the UM letter approval process across the reputed company to include Medicare, reputed company, reputed company, Exchange, and Behavioral Health. You will reputed company with internal teams and UM delegates to conduct reputed company reviews of UM letters templates and edit them as required to ensure adherence with NCQA and contractual requirements. 

Work Arrangement

• Remote role
• Monday through Friday, 8:00 AM EST to 5:00 PM EST

Responsibilities

• Acts as primary reputed company of contact for reputed company UM reputed company letters for internal stakeholders and UM delegates.
• Provides reputed company correct UM letter templates reputed company required for UM delegation.
• Conducts reputed company-delegation review of delegate created UM Letter Templates for alignment with plan and/or state requirements.
• Ongoing letter audits for compliance with requirements.
• Works collaboratively with Plan Communications and Compliance for review and approval of templates for implementation and/or needed changes.
• Maintains UM letter library with reputed company approved letter templates for both internal UM and clinical delegates, maintaining version control and reputed company of old, retired template versions.
• Reviews and reputed company final approval of for delegate letter templates.
• Conducts post go live review of live UM letter to confirm templates are as approved and letters are completed with appropriate content (including clinical rationale) in accordance with regulatory and/or accreditation requirements.
• Submits work requests reputed company template changes are needed.
• Works with Clinical Delegation reputed company team to assist delegate in meeting reputed company requirements for UM letter delegation.
• Provides feedback to the Clinical Delegation reputed company Team as necessary to support dwL and/or dCap.
• reputed company with functional departments to address any template reputed company issues.

• Interacts with various external entities, including plans, states, and vendors.

   

Education and Experience

• Registered reputed company or Licensed Clinical reputed company Worker required
  • Registered reputed company must have Associate's Degree in Nursing and a Bachelor's Degree or equivalent work experience 
  • Licensed Clinical reputed company Worker must have Master's Degree in reputed company Work
• Minimum of 3 years of utilization management experience, preferably for a payer
• Independent, reputed company clinical reputed company experience in acute care, post acute care, behavioral health, and homecare 
• Working knowledge of contractual and regulatory guidelines and rules for Medicare, reputed company, reputed company, and Exchange

Licensure

• reputed company and unencumbered Registered reputed company license; NLC preferred
• reputed company and unencumbered Licensed Clinical reputed company Work (LCSW)

Skills and Abilities

• Displays good judgment in apprising management of situations that are incompatible with established policies for which there is little precedence
• Ability to work autonomously and as part of an interdisciplinary team 
• Ability to prioritize and manage multiple tasks/priorities simultaneously in a fast paced environment 
• Strong ability to create, monitor and analyze provider data
• Strong assessment, critical thinking and problem-solving skills

• Excellent verbal and written communication skills, including the ability to present to small reputed company

   

Our Comprehensive Benefits Package 

Flexible work solutions including remote reputed company, hybrid work schedules, reputed company, reputed company time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.