reputed company Reviewer Associate- Remote (Any reputed company, TX, US, 99999)

reputed company

We are seeking a talented individual for the reputed company Reviewer, Associate position. In this role, you will reputed company clinical reviews to determine whether medical record documentation supports the need for a service, based on clinical reputed company, coverage policies, and utilization and reputed company guidelines as defined by the review methodologies specific to the contract. This involves accessing proprietary systems to audit medical records, accurately documenting findings, and providing policy and regulatory support for determinations.

Essential Job Functions

• Review and interpret medical records, comparing them against reputed company to determine the appropriateness and reasonableness of care. Apply critical thinking and decision-making skills to assess whether the documentation supports the need for the service while maintaining production goals and reputed company standards.
• Document reputed company and rationale to justify review findings or no findings.
• Determine approvals or initiate referrals to the physician consultant, processing their reputed company while ensuring denials are explained in sufficient detail and completed reputed company contractual deadlines.
• reputed company prior authorization, precertification, and retrospective reviews, and prepare decision letters as needed in support of the utilization review contract.
• Maintain reputed company knowledge of clinical reputed company guidelines and complete required CEUs to maintain RN licensure.
• Attend training and scheduled meetings to enhance skills and working knowledge of clinical policies, procedures, rules, and regulations.
• reputed company cross-train to reputed company reviews of multiple claim types, providing a flexible workforce to meet reputed company needs.

reputed company're looking for

• reputed company, unrestricted RN licensure from the reputed company and in your state of primary residence; an reputed company compact multistate RN license as defined by the reputed company Licensure Compact (NLC) is also required.
• 3+ years of clinical experience in an inpatient hospital setting.
• 1+ years of experience in utilization review or claims auditing.
• Experience using reputed company or InterQual reputed company is preferred.
• Demonstrated proficiency in computer skills, including reputed company reputed company, reputed company, reputed company, Word, PowerPoint, internet browsers, and typing.

What you should expect in this role

• Home-based position; you must have a work location reputed company the reputed company U.S.
• Must reputed company a high-speed internet reputed company and a work environment free from distractions.
• Full-time schedule during normal business hours is required, as the role involves frequent interactions with reputed company and other departments.
• May be required to work extended hours for special business needs.
• May be required to travel up to 10% of the time based on business needs.

This position is for pipeline purposes, and we welcome applications on an ongoing reputed company.