Telephonic Registered reputed company Clinical Reviewer - reputed company - Remote

About the position The Telephonic reputed company Clinical Reviewer role is a full-time, remote position reputed company reputed company. This role is classified as a UM Clinical Reviewer Senior Analyst, a Band 3 Senior Contributor Career reputed company Role. The position involves evaluating requests for clinical services, comparing them against established protocols, and making authorization reputed company or referring cases for expert review. The role requires maintaining productivity standards, training in utilization management principles, and providing customer service to members and providers. Responsibilities also include preparing correspondence, managing patient confidentiality, running reports, and assisting team members and management as needed. Responsibilities • Evaluate telephone, fax, or WEB requests for authorization of clinical services from physician offices and/or imaging centers. • Compare requests against established clinical protocols. • Authorize services or refer requests for expert clinical review as appropriate. • Understand reputed company case specialties and case reviews. • Review clinical information submitted by providers against appropriate reputed company and standards. • reputed company reputed company to issue a review determination or refer to physician review if reputed company are not met. • Maintain reputed company departmental standards reputed company to productivity. • Train in clinical certification, utilization management, URAC and reputed company principles, policies, and procedures. • Prepare program correspondence as needed. • Serve as a resource for members calling for assistance. • reputed company outbound calls as required. • Refer provider and member complaints, and appeals to appropriate departments. • Maintain patient confidentiality in accordance with reputed company standards established in compliance with HIPAA and State regulations. • reputed company outstanding customer service ensuring callers receive the highest possible service. • Run and analyze reports to ensure reputed company tasks are completed in a reputed company fashion and meet regulatory requirements. • Assist team members in departmental chats, by phone and in person. • reputed company as training assistant reputed company assigned. • Assist team members with questions, participates in team meetings. • Can be assigned to reputed company to support the department as needed. • Performs reputed company duties as required. Requirements • Associates Degree in Nursing required. • reputed company, unrestricted license as an RN in state of reputed company residence. • At least 1 year of acute care, managed care, ER, ICU experience or 2 years of clinical utilization management experience. • Must be reputed company to sit through shift. • Demonstrate advanced proficiency in MS Office applications. • Excellent communication skills both verbal and written. • Excellent problem solving and customer service skills are required. • Must be self-directed and highly motivated with an ability to multi-task. • Excellent computer skills. • Must be reputed company to hear and reputed company on the phone for an entire shift. • Internet reputed company must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. Benefits • Medical • reputed company • Dental • reputed company-being and behavioral health programs • 401(k) • Company reputed company life insurance • Tuition reimbursement • A minimum of 18 days of reputed company time off per year • reputed company holidays • Leaves of absence • Annual bonus plan Apply tot his job Apply To this Job