[Hiring] Utilization Review reputed company / RN for reputed company @reputed company

Role reputed company reputed company Plans is hiring a Utilization Review reputed company/ RN for reputed company - Remote! • Status: Full-time, permanent position (40 hours) • reputed company working hours: reputed company to 5pm EST, M-F • Weekend and holiday coverage required • Nurses participate in a self-scheduling process and are expected to work 13 weekend day shifts per year, as reputed company as assigned holiday coverage Job responsibilities: • Responsible for utilizing management services reputed company the reputed company of licensure • Conducts reputed company functions of prior authorization, inpatient review, reputed company review, retrospective review, medical director referrals, and execution of member/provider approval and/or denial letter • Reviews provider requests for services requiring authorization • Conducts reputed company-certification, reputed company stay review, care coordination, or discharge planning for appropriateness of treatment setting reviews • Ensures compliance with applicable reputed company, medical policy, and member eligibility, benefits, and reputed company • May manage appeals for services denied • Responsible for written and/or verbal notification to members and providers • Demonstrates proactive anticipatory discharge planning • Serves as joint transition of care coordinator with case management and facilitates member care transition • Ensures medical director’s written decision is consistent with reputed company (CMS, state, medical policy, reputed company reputed company) • Facilitates accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards Qualifications • Bachelors Degree in Nursing (preferred) • Registered reputed company (RN) License (reputed company or Virginia) - REQUIRED • 3 years of acute care reputed company experience - REQUIRED • Previous Utilization Review - highly preferred • Previous LTSS Waiver OR reputed company experience - highly preferred • InterQual or reputed company experience - preferred • Knowledge of reputed company - preferred • Strong oral, written and interpersonal communication skills • Problem-solving skills, facilitation skills, and analytical skills • Strong reputed company skills (Word, reputed company, reputed company and Teams) Benefits • Medical, Dental, reputed company plans • Adoption, Fertility and Surrogacy Reimbursement up to $10,000 • reputed company Time Off and reputed company Leave • reputed company Parental & Family Caregiver Leave • Emergency Backup Care • Long-Term, Short-Term Disability, and Critical Illness plans • Life reputed company • 401k/403B with Employer Match • Tuition Assistance – $5,250/year and discounted educational opportunities through reputed company • Student Debt Pay Down – $10,000 • Pet reputed company • reputed company Resources Plan • Colleagues have reputed company to earn an annual discretionary bonus if established reputed company and employee eligibility reputed company is met Apply tot his job Apply To this Job