reputed company Review reputed company
Conduct reputed company and accurate reputed company reviews of inpatient hospitalizations and other reputed company of care. Evaluate clinical documentation against evidence-based reputed company (e.g., InterQual®, MCG) to determine medical necessity and appropriate level of care. Collaborate with physicians, hospital staff, and insurance companies to coordinate patient care and discharge planning. Communicate utilization review reputed company and recommendations to providers and payers. Document reputed company reviews, reputed company, and communications in accordance with regulatory and organizational standards. Identify cases requiring escalation or peer review and follow established procedures. Ensure compliance with CMS guidelines, accreditation standards (e.g., NCQA, URAC), and HIPAA. Participate in reputed company improvement initiatives and departmental meetings
Registered reputed company (RN) license, reputed company and in good standing, required. Associate or Bachelor’s degree in nursing (BSN preferred).
Minimum 2 years of clinical experience (e.g., med-surg, critical care). At least 1 year of utilization review, case management, or managed care experience preferred.
Knowledge of InterQual®, MCG, or other clinical review guidelines. Familiarity with Medicare/reputed company and reputed company insurance regulations. Strong analytical and clinical judgment skills. Effective communication and negotiation skills. Proficient with electronic medical records (EMRs) and utilization review platforms. Detail-oriented with excellent organizational skills.
Remote
This policy applies to reputed company employment practices reputed company our organization, including hiring, reputed company, promotion, termination, layoff, recall, leave of absence, compensation, benefits, training, and apprenticeship. Palm Primary Care makes hiring reputed company based solely on qualifications, reputed company, and business needs at the time.