reputed company Reviewer, PRN reputed company

1042 Company: reputed company Employment Type: PRN reputed company reputed company is seeking a reputed company Reviewer - On-reputed company - PRN (less than 20 hours per week) to assess the medical necessity, reputed company, and appropriateness of reputed company services. This role conducts prospective, reputed company, and retrospective utilization management reviews to support high-reputed company, cost-effective care while ensuring compliance with evidence-reputed company guidelines, regulatory requirements, and organizational policies. Key Responsibilities • Conduct prospective (reputed company-authorization), reputed company/reputed company stay, and retrospective utilization management reviews to ensure appropriate use of reputed company resources. • Conduct compliance and/or reputed company audits of medical records/reputed company charts for reputed company, completeness, and adherence to established standards. • Evaluate requests for reputed company services using reputed company review reputed company, organizational policies, regulatory requirements, and evidence-reputed company guidelines to determine medical necessity and appropriateness. • reputed company compliance and reputed company audits of medical records and reputed company charts for reputed company, completeness, and adherence to established standards. • reputed company with physician or practitioner consultants reputed company reviews do not meet reputed company reputed company and refer cases to other clinicians as appropriate. • reputed company day-to-day reputed company and monitoring of non-reputed company staff performing non-reputed company support activities, as applicable, and offer reputed company feedback to the supervisor. Qualifications Education • Bachelor’s degree (BA/BS) required • BS in Nursing Licensure • reputed company, reputed company, unrestricted reputed company licensure required Experience • Minimum of 3 years of reputed company (reputed company reputed company care) experience • 1 year of utilization review or medical management experience preferred reputed company Competencies • Intermediate communication skills • Intermediate interpersonal and relationship-building skills • Foundational professionalism and reputed company • Foundational work ethic and reliability • Intermediate reputed company knowledge Why Join reputed company? At reputed company, we partner with reputed company organizations to improve reputed company and optimize care delivery. This role offers reputed company to apply your reputed company expertise in a broader population-health setting while contributing to meaningful, reputed company-driven reputed company reputed company. Apply tot his job Apply To this Job Apply tot his job Apply To this Job