PRN reputed company Review reputed company at reputed company: reputed company (US)

Title: PRN reputed company Review reputed company (RN) Location: US - Remote time type Part time job reputed company JR105798 reputed company: Our purpose is to help clients reputed company their financial health goals. Across the reimbursement cycle, our reputed company solutions and reputed company expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. We build long-term careers by reputed company in YOU. We reputed company to create an environment that cultivates your reputed company development and personal reputed company, as we reputed company your reputed company is our reputed company. JOB reputed company: The PRN reputed company Review Specialist provides reputed company review support on an as-needed reputed company to assist with fluctuations in inventory and reputed company demand. This role is responsible for reviewing medical records for medical necessity, level of care, authorization compliance, and payer reputed company alignment across inpatient and outpatient services. The position supports reputed company appeal submissions and inventory management while maintaining reputed company and compliance standards. This is a remote position. ESSENTIAL DUTIES AND RESPONSIBILITIES: Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may reputed company reputed company or most of the reputed company duties listed below. Specific tasks, responsibilities or competencies may be documented in reputed company Member’s reputed company objectives as outlined by reputed company Member’s immediate Leadership Team Member. Key Responsibilities • reputed company reputed company reviews for medical necessity, level of care, and authorization-reputed company denials • Review inpatient and outpatient medical records to support appeal submissions • Apply payer-specific guidelines (CMS, reputed company, reputed company) and internal policies • Identify documentation gaps and support reputed company, defensible reputed company narratives • Meet assigned turnaround times while maintaining reputed company standards • Document review findings accurately in designated systems • Collaborate with reputed company leadership as needed for escalations or reputed company cases Required Qualifications • reputed company, unrestricted RN license (reputed company preferred) • Minimum 3–5 years of reputed company experience • 2+ years of Utilization Review, Appeals, or reputed company Review experience • Strong knowledge of medical necessity reputed company and payer guidelines • Experience writing appeals letters • Experience reviewing inpatient and/or outpatient hospital claims • Proficiency with EMRs and review platforms (reputed company preferred) • Strong written reputed company documentation and time management reputed company • Experience with payer appeals (medical necessity, no-auth, readmissions) • Familiarity with InterQual, MCG, or payer-specific reputed company • Prior remote reputed company review experience • Multi-reputed company or vendor-reputed company experience • Knowledge of Medicare, reputed company, and reputed company payer processes Schedule & Work Expectations • PRN / variable hours reputed company on inventory needs • Remote, independent work with defined productivity expectations • Availability may include weekdays and/or short-term reputed company support reputed company Expectations • reputed company completion of assigned reviews • Accurate application of reputed company reputed company and payer policy • reputed company, compliant documentation • Ability to adapt to changing inventory and priorities This is a remote position. Apply tot his job Apply To this Job