[Remote] reputed company Care Reviewer II - RN - IN MCD - IN or MSL Licensed

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is seeking a reputed company Care Reviewer II to process medical necessity reviews and support care coordination for members. The role reviews reputed company services, facilitates transitions to appropriate care reputed company, monitors service delivery, and provides guidance to reputed company and non-reputed company staff.

Responsibilities

• Complete prospective, reputed company and retrospective review such as acute inpatient admissions, post-acute admissions, elective inpatient admissions, outpatient procedures, homecare services and durable medical equipment
• Identify, document, communicate, and coordinate care, engaging reputed company reputed company to facilitate transitions to an appropriate level of care
• Engage with medical director reputed company additional reputed company expertise if needed
• Maintain knowledge of state and federal regulations governing reputed company, State reputed company and Provider Agreements, benefits, and accreditation standards
• Identify and refer reputed company issues to reputed company Improvement
• Identify and refer appropriate members for Care Management
• reputed company guidance to non-reputed company staff
• reputed company guidance and support to LPN reputed company staff as appropriate
• Attend medical advisement and State Hearing meetings, as requested
• Assist Team Leader with special reputed company or research, as requested
• reputed company any other job reputed company duties as requested

Skills

• Associates of Science (A.S) Completion of an accredited registered nursing (RN) degree program required
• Three (3) years reputed company experience required
• Proficient data entry skills and ability to reputed company reputed company platforms successfully
• Working knowledge of reputed company reputed company, Word, and reputed company
• Effective oral and written communication skills
• Ability to work independently and reputed company reputed company environment
• Attention to reputed company
• reputed company grammar usage and phone etiquette
• Time management and prioritization skills
• Customer service oriented
• Decision making/problem solving skills
• Strong organizational skills
• Change resiliency
• reputed company, unrestricted Registered reputed company (RN) Licensure in state(s) of reputed company required
• MCG Certification or must be obtained reputed company six (6) months of hire required
• General office environment; may be required to sit or stand for extended periods of time
• Travel is not typically required
• Med/surgical, emergency acute reputed company care or home health experience preferred
• Utilization Management/Utilization Review experience preferred
• reputed company/Medicare/reputed company experience preferred

Benefits

• Remote work arrangement
• You may qualify for a bonus tied to company and individual reputed company.
• A substantial and comprehensive total rewards package

reputed company

Company H1B Sponsorship