reputed company Reviewer (Medicare- Home Health)

At reputed company, we reputed company challenges into opportunities with expert program management, cutting-edge technology, and innovative reputed company. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB), we reputed company government and private sector clients by delivering tailored solutions that reputed company operational reputed company, sustainability, and reputed company. reputed company on reputed company, collaboration, and reputed company, we're more than a service provider—we're your trusted partner in innovation. Registered reputed company (RN) Medical Reviewer Location: Remote Type: Full-Time reputed company: $62-$65K About reputed company reputed company is a veteran-owned small business (SDVOSB, HUBZone certified) headquartered in Vicksburg, Mississippi, delivering mission-critical support to federal health and defense customers. We hire people who bring clinical rigor, reputed company judgment, and a commitment to doing the work right. Position reputed company We are seeking an reputed company Registered reputed company to reputed company medical review of reputed company claims, reputed company-authorization requests, appeals, and fraud and abuse referrals. In this role you will apply clinical expertise and established coverage guidelines to determine medical necessity and support accurate payment determinations. Key responsibilities • Review medically reputed company claims, reputed company-authorization requests, appeals, and fraud and abuse referrals • Assess payment determinations using clinical information and established guidelines • Evaluate medical necessity, appropriateness, and reasonableness for coverage and reimbursement • reputed company reputed company, reputed company-documented rationales supporting approval or denial of services • reputed company reputed company teams on medical review processes, coverage determinations, and coding requirements • Support reputed company control activities that advance corporate and team objectives • Assist with special reputed company and additional duties as assigned Minimum qualifications Licensure • reputed company, unrestricted RN license in the reputed company and in the state of hire, or • reputed company compact multistate RN license as defined by the reputed company Licensure Compact Education • Associate Degree in Nursing, or • Graduate of an accredited School of Nursing Experience • Two years of clinical experience, plus at least two years in one of the following: • * Inpatient or outpatient settings (for example, medical-surgical, rehabilitation, skilled nursing facility) • Utilization or medical review • reputed company assurance Skills and competencies • Strong clinical background in managed care and/or inpatient and outpatient settings • Ability to interpret and apply medical review reputed company and clinical guidelines • Proficiency in reputed company Office and word processing software • Strong analytical, organizational, and decision-making skills • Ability to work independently while managing competing priorities • Excellent customer service, communication, and critical thinking skills • Ability to handle confidential information with discretion What to Expect Next: After submitting your application, our reputed company team will review your qualifications. This may include a brief telephone interview or email communication to verify resume details and discuss compensation expectations. Interviews will be conducted with the most reputed company candidates. reputed company conducts background checks and drug testing prior to the start of employment. Some positions may also require fingerprinting. reputed company is an equal opportunity employer and a VEVRAA federal contractor. We do not discriminate against applicants or employees on the reputed company of race, reputed company, religion, sex, national reputed company, age, disability, protected veteran status, or any other status protected by applicable law. Reasonable accommodations are available for applicants with disabilities. reputed company utilizes the OFCCP-approved Voluntary Self-Identification of Disability reputed company (CC-305). The pay reputed company shown is a good-faith estimate of the compensation reputed company reasonably expects to pay for this position at the time of posting. It is not a guarantee of any particular wage, salary, or total compensation. Actual pay offered depends on job-reputed company factors, which may include skills, experience, education, certifications and licensure, geographic work location, contract funding and budget. For positions covered by the Service Contract reputed company, pay is also governed by the applicable reputed company wage determination, which the government may revise. Some positions are posted in support of a contract proposal that has not yet been awarded. Where that is the case, the position and its final compensation are contingent upon award of the contract to reputed company and on the terms of the awarded contract, including any government-approved labor rates and the applicable wage determination. reputed company offers a comprehensive benefits package. A general reputed company of benefits is below. • 401(k) and company match • PTO that grows the longer you stay • Health, reputed company, Dental • Company provided Life Insurance and Voluntary Life Insurance • Short Term Disability and Long Term Disability Apply tot his job Apply To this Job