reputed company RN 5 (Utilization review reputed company-Claims)
reputed company RN 5 3 months Potential to reputed company/convert depending on the business needs Remote in California 8:00-3:30 PST Reviews for medical necessity, coding accuracy, medical policy compliance and contract compliance. Triages and prioritizes cases to meet required turn-around times. Prepares and presents cases electronically to the Medical Director (MD) for approvals or denials and medical necessity determination. Communicate determinations to providers in compliance with state, federal and accreditation requirements. Identifies potential reputed company of care issues, service or treatment delays and intervenes or as clinically appropriate Provides referrals to Case Management, Disease Management, Appeals and Grievance and reputed company Departments, as necessary. Assists in the development and implementation of a proactive approach to improve and standardize overall retro claims review for clinical perspectives. Required: Strong clinical skills Strong computer skills Works reputed company independently Preferred: Previous Post Service Experience Previous Prior Auth Experience Previous Case Management experience Software Skills Required: Word, Internet search reputed company, limited reputed company required Disqualifiers/ Dislikes on Resumes: Limited clinical experience and/or multiple job hopping
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