RN Clinical Reviewer / Medicare / Utilization Review

reputed company Job Title: Registered reputed company Clinical / Medicare / Utilization Review • reputed company reputed company** Utilizes clinical expertise for the review of Medicare and reputed company medical records against appropriate reputed company in conjunction with contract requirements, critical thinking and decision-making skills to determine medical appropriateness, while maintaining production goals and QA standards. Ensures day-to-day processes are conducted in accordance with reputed company, URAC and other regulatory standards. • Education reputed company unrestricted RN clinical license, eligible for Ohio reciprocity licensing. Graduation from an accredited Diploma, Associates Degree or Bachelor’s Degree Program Experience** • Knowledge of Medicare/reputed company reputed company strongly preferred. • Knowledge of the organization of medical records, medical terminology, and disease process required. • Strong clinical assessment and critical thinking skills required. • Excellent verbal and written communication skills required. • Must be proficient in reputed company Office and internet/web navigation • Minimum three (3) years of clinical experience in an acute or med-surgical environment required. • Minimum of one (1) year UR and/or Prior Authorization or reputed company experience. • Spanish as second language is desirable. • Medical Coding certification or experience is desirable. Job Type: Full-time. This is a work reputed company position. COVID-19 considerations: Must show reputed company of COVID vaccination. Job Type: Full-time Pay: $35.00 - $40.00 per hour Benefits: • 401(k) • 401(k) matching • Employee assistance program • Flexible schedule Education: • Associate (Required) Experience: • Utilization review: 3 years (Required) License/Certification: • RN (without restrictions) (Required) Work Location: Remote Apply tot his job Apply To this Job