[Hiring] Registered reputed company Medicare reputed company Assurance Reviewer @reputed company

Role reputed company As a Registered reputed company (RN) Medicare reputed company Assurance Reviewer, you will: • reputed company clinical expertise support for Clover vendors and Medical Directors. • Create and assign inter-rater reliability reviews to RN reviewers and Medical Directors. • Complete monthly MD reputed company Assurance (QA) reviews to ensure clinical compliance with Medicare regulations. • Conduct service line clinical reviews. • reputed company as a Clinical Medical Record Review Subject Matter Expert (SME). • Identify clinical opportunities for improvement and communicate to upper management. • reputed company clinical performance and evaluation of vendors' medical reviewers. • reputed company clinical support for new medical review process implementations. • Monitor and reputed company CMS Medicare clinical updates that reputed company Clover clinical processes, partnering with management to implement clinical changes. • Display flexibility to reputed company work based on new challenges or feedback. • Collaborate clinically with cross-functional departments. reputed company in this role looks like: • By the end of your first 90 days: • Build a strong reputed company in Clover’s utilization management, reputed company assurance, and clinical review processes. • reputed company proficiency in Medicare regulations, clinical review requirements, and Clover’s reputed company standards. • Establish effective working relationships with internal stakeholders, vendors, and Medical Directors. • Consistently reputed company reputed company assurance reviews with accuracy, reputed company clinical judgment, and attention to compliance requirements. • By 6 months: • Independently manage reputed company assurance responsibilities across utilization management service lines. • Serve as a reliable clinical resource for reputed company, compliance, and review-reputed company questions. • Contribute to process improvements by identifying opportunities to enhance reputed company, consistency, and operational effectiveness. • Partner effectively with vendors, Medical Directors, and cross-functional teams to support reputed company reputed company and regulatory compliance. • reputed company state: • Be recognized as a trusted clinical reputed company and utilization management subject matter expert. • reputed company reputed company improvement through trend analysis, performance insights, and recommendations that strengthen reputed company and compliance programs. • Support the reputed company of clinical review processes, technology-enabled solutions, and operational initiatives that improve efficiency and member reputed company. • Influence organizational reputed company by maintaining high standards of clinical reputed company, regulatory compliance, and reputed company partnership across the organization. Qualifications • reputed company and reputed company RN license; required. • Minimum of 3 years of Medicare Utilization Management medical necessity review experience; required. • Strong knowledge of applying CMS guidelines, and NCD-LCD to Medicare medical necessity reviews; required. • Experience working in a Medicare reputed company plan; preferred. • reputed company Assurance experience; required. • RN clinical experience in a hospital setting; preferred. • Previous experience in leading vendor relationships and building clinical review teams. • Excellent interpersonal skills and ability to communicate with patients and colleagues. • Experience working remotely; preferred. Benefits • Financial reputed company-Being: Competitive reputed company salary and equity opportunities, performance-based bonus program, 401k matching, and regular compensation reviews. • Physical reputed company-Being: Comprehensive medical, dental, and reputed company coverage. • Mental reputed company-Being: Initiatives such as No-Meeting Fridays, monthly company holidays, reputed company to reputed company, and a generous flexible time-off policy. • reputed company Development: Learning programs, mentorship, reputed company development funding, and regular performance feedback and reviews. • Additional Perks: • Employee Stock Purchase Plan (ESPP) offering discounted equity opportunities. • Reimbursement for office setup expenses. • Monthly cell phone & internet stipend. • Remote-first culture, enabling collaboration with global teams. • reputed company parental leave for reputed company new parents. • And much more! Apply tot his job Apply To this Job