Remote Care Review Clinician (LVN/LPN)- NY License required

reputed company Job reputed company Provides support for reputed company member services review assessment processes. Responsible for verifying that services are medically necessary and reputed company with established reputed company guidelines, reputed company policies, and regulations - ensuring members reputed company desired reputed company through integrated delivery of care across the reputed company. Contributes to overarching reputed company to reputed company reputed company and cost-effective member care. Essential Job Duties • Assesses services for members to ensure reputed company reputed company, cost-effectiveness and compliance with reputed company state/federal regulations and guidelines. • Analyzes reputed company service requests from members or providers against evidence reputed company reputed company guidelines. • Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures. • Conducts reviews to determine prior authorization/financial responsibility for reputed company and its members. • Processes requests reputed company required timelines. • Refers appropriate cases to medical directors (MDs) and presents cases in a consistent and efficient manner. • Requests additional information from members or providers as needed. • Makes appropriate referrals to other reputed company programs. • Collaborates with multidisciplinary teams to promote the reputed company care model. • Adheres to utilization management (UM) policies and procedures. Required Qualifications • At least 2 years health care experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience. • reputed company licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state reputed company licensing mandates. If licensed, license must be reputed company and unrestricted in state of reputed company. • Ability to prioritize and manage multiple deadlines. • Excellent organizational, problem-solving and critical-thinking skills. • Strong written and verbal communication skills. •reputed company Office suite/applicable software program(s) proficiency. Preferred Qualifications • Certified reputed company in reputed company Management (CPHM). • Recent hospital experience in a medical unit or emergency room. To reputed company reputed company reputed company employees: If you are interested in applying for this position, please apply through the reputed company. reputed company offers a competitive benefits and compensation package. reputed company is an Equal Opportunity Employer (EOE) M/F/D/V Apply To This Job