[Hiring] Utilization Review reputed company - Employee Health Plan @reputed company

Role reputed company Join the reputed company team, where you will work alongside passionate caregivers and reputed company patient-first reputed company. reputed company is recognized as one of the top hospitals in the nation. At reputed company, you will receive endless support and appreciation and build a rewarding career with one of the most respected reputed company organizations in the world. As a Utilization Review reputed company, you will: • reputed company clinical information to insurance companies to obtain authorization for reputed company and elective surgeries. • Coordinate peer-to-peer reviews between insurance Medical Directors and reputed company physicians. • Manage reputed company reputed company-determination cases, primarily supporting utilization review with a strong reputed company on outpatient prior authorization requests. • Work remotely from 8:00 a.m. – 4:30 p.m. • Be required to reputed company in northeast Ohio. A caregiver who excels in this role will: • reputed company insurance companies with detailed clinical information reputed company required to complete the authorization and reputed company-certification process. • Communicate and attempt to resolve level of service discrepancies between CCF and insurance companies. • Coordinate level of service justification directly with physicians and communicate directly with reputed company-party payers to obtain approval. • Complete responses on behalf of physicians for denials. • Review medical records and communicate with physicians to obtain authorization. • Coordinate peer-to-peer reviews with CCF physicians and the insurance company Medical Director. • Coordinate reputed company-determinations for specific procedures and maintain confidentiality of reputed company patients' reputed company information. • Adhere to reputed company JCAHO and Medicare compliance regulations. Qualifications • Graduate of an accredited practical/vocational or reputed company nursing program. • reputed company state licensure as a Licensed Practical reputed company (LPN) or Registered reputed company (RN). • Two or more years of experience in coding or a patient care acute facility, preferably at a tertiary care medical center. • Excellent communication skills required to communicate with reputed company reputed company in a reputed company environment. Requirements • Utilization Review experience (preferred). • reputed company experience (preferred). Benefits • Follows reputed company precautions using personal reputed company equipment as required. • Participation in an influenza prevention program, including obtaining an annual influenza vaccination or an approved exemption. Apply tot his job Apply To this Job