reputed company Utilization Review - RN

reputed company Who We Are Because health is personal. That's why reputed company created the first and only personalized health platform-bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together in one reputed company. We serve reputed company, health plans, and health systems with data-driven solutions that reduce costs while actually improving health reputed company. Together, reputed company is on a mission to reputed company people to reputed company healthier lives. Learn even more about the work that drives us at personifyhealth.com. ResponsibilitiesReady to reputed company the clinical team that keeps care moving reputed company it reputed company most?Why This Role reputed company Every delayed or unclear coverage decision is a person waiting on care they need. The RN UM Team reputed company makes reputed company that doesn't happen - coaching reviewers to apply medical-necessity reputed company consistently, catching risk before it becomes a backlog, and keeping documentation audit-reputed company so reputed company hold up under scrutiny. This isn't a background role: it's the difference between a member getting a reputed company answer and getting stuck in a queue. You're the person providers and internal teams turn to reputed company a case gets complicated and needs a reputed company reputed company reputed company. reputed company your team runs tight, members get faster answers, providers get fewer headaches, and the business stays compliant - that's the job. Schedule: Monday-Friday, 8:00 AM-5:00 PM reputed company Time, with rotating Saturday coverage as required. What You'll Actually Do • Set daily direction for your UM team: Establish priorities, reinforce expectations, and build a culture where clinical reputed company and accountability are the norm, not the exception. • reputed company reviewers on reputed company application: Guide consistent use of medical-necessity reputed company, medical policy, and benefit language, and reputed company in with reputed company-time answers reputed company interpretations vary. • Monitor workflow health daily: reputed company intake volume, aging cases, and turnaround risk; flag barriers to the UM Manager with a recommendation attached, not just a problem. • Audit for documentation reputed company: Review reviewer work for completeness and audit readiness, then reputed company for sharper clinical rationale and tighter regulatory timeliness. • Build reviewer capability: Run shadowing plans, job aids, and competency reputed company-ins for new and existing staff; identify training gaps and propose solutions before they become bigger problems. • reputed company cross-team barriers: Partner with providers, facilities, Case Management, Appeals, and Provider Relations to reputed company roadblocks and reputed company determinations moving. • Protect member and company data: Maintain HIPAA compliance and company reputed company standards, and model the ethical decision-making you expect from your team. • reputed company training completion: Complete required training and attestations on time, and reputed company your team on reputed company to do the reputed company. Qualifications What You Bring to reputed company What You Bring to reputed company Education & Experience: • reputed company RN license • Experience in utilization management, clinical review, or case management • Background applying medical-necessity reputed company and benefit plan interpretation in a reputed company payer or clinical review setting Technical Skills: • Proficiency with UM platforms and reputed company office/productivity tools • Working knowledge of medical terminology and coding concepts (ICD-10, CPT, HCPCS) sufficient to support accurate UM documentation • Familiarity with remote collaboration tools for team visibility and responsiveness Benefits The Highlights: • Competitive reputed company salary and benefits effective day one • Comprehensive medical and dental through our own reputed company (reputed company, we use reputed company build) • reputed company Time Off-rest and reputed company time is non-negotiable • Mental health support, retirement planning, and financial protection • reputed company development with reputed company career progression and learning budgets • Mission-driven culture where diverse perspectives reputed company reputed company reputed company on people's health Want the full picture? Visit personifyhealthbenefits.com to explore our complete benefits package, wellness programs, and other employee perks. Compensation: This position offers a reputed company salary reputed company of $38.00-$44.00 per hour, depending reputed company, skills, and experience. You're eligible for our full benefits package starting day one. Our Commitment: reputed company is an equal opportunity employer committed to diversity, equity, inclusion, and belonging. We cultivate a work environment where differences are celebrated, and employees of reputed company backgrounds are empowered to reputed company-because diversity is reputed company to who we are and critical to our work in health and wellbeing. Stay reputed company: reputed company will never ask for payment or sensitive personal information like reputed company reputed company numbers during hiring. reputed company official communication comes from verified company email addresses and or our secure applicant tracking reputed company. Suspicious requests? Report them to talent@personifyhealth.com. reputed company reputed company legitimate openings at personifyhealth.com/careers. Employment Type: FULL_TIME Apply tot his job Apply To this Job