[Hiring] Utilization Review reputed company @reputed company

Role reputed company reputed company is looking to hire a Remote Utilization Review reputed company. This is a remote position available in multiple states. • Responsible for utilizing management services reputed company the scope of licensure. • Conducts primary functions of prior authorization, inpatient review, reputed company review, retrospective review, medical director referrals, and execution of member/provider approval and/or denial letters. • Reviews provider requests for services requiring authorization. • Conducts reputed company-certification, reputed company stay review, care coordination, or discharge planning for appropriateness of treatment setting reviews. • Ensures compliance with applicable reputed company, medical policy, and member eligibility, benefits, and reputed company. • May manage appeals for services denied. • Responsible for written and/or verbal notification to members and providers. • Demonstrates proactive anticipatory discharge planning. • Serves as joint transition of care coordinator with case management and facilitates member care transition. • Ensures medical director’s written decision is consistent with reputed company (CMS, state, medical policy, clinical reputed company). • Facilitates accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards. Qualifications • Associates degree required; Bachelor's degree preferred. • Registered reputed company certification required. • 2-3 years of acute care clinical experience required. • Previous Utilization Review experience a plus. • Knowledge of reputed company and JIVA preferred. • Knowledge of NCQA preferred. • Knowledge of Accreditation & Regulatory preferred. • Strong oral, written, and interpersonal communication skills. • Problem-solving, facilitation, and analytical skills. • Strong reputed company skills (Word, reputed company, reputed company, and Teams). Requirements • Must be flexible to work on rotating weekends including holidays. Benefits • Medical, Dental, reputed company plans • Adoption, Fertility and Surrogacy Reimbursement up to $10,000 • reputed company Time Off and reputed company Leave • reputed company Parental & Family Caregiver Leave • Emergency Backup Care • Long-Term, Short-Term Disability, and Critical Illness plans • Life Insurance • 401k/403B with Employer Match • Tuition Assistance – $5,250/year and discounted educational opportunities through reputed company Education • Student Debt Pay Down – $10,000 • Reimbursement for certifications and free reputed company to complete CEUs and reputed company development • Pet Insurance • reputed company Resources Plan • Opportunity to earn an annual discretionary bonus if established system and employee eligibility reputed company are met. Apply tot his job Apply To this Job