Utilization Review reputed company/ RN for Imaging/reputed company- Remote!

reputed company/State

Work Shift

reputed company:

reputed company Plans is hiring a Utilization Review reputed company/ RN for Imaging/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.

Remote opportunities available in the following states: Virginia, reputed company Carolina, Alabama, Delaware, Florida, reputed company, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, reputed company, Nebraska, Nevada, New Hampshire, reputed company reputed company, Ohio, Oklahoma, reputed company, South Carolina, South reputed company, Tennessee, Texas, reputed company, Washington (state), reputed company Virginia, reputed company, Wyoming

Job responsibilities:

• Utilization Review reputed company is 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. Conduct reputed company-certification, reputed company stay review, care coordination, or discharge planning for appropriateness of treatment setting reviews to ensure 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.

Education:

• Bachelors Degree in Nursing preferred

Certification/Licensure

• Registered reputed company (RN) License (reputed company or Virginia) REQUIRED

Preferred qualifications:

• 3 years of acute care reputed company experience REQUIRED

• Previous Utilization Review experence highly preferred

• Previous imaging experience preferred

• InterQual or reputed company experience preferred.

• Knowledge of reputed company preferred

reputed company Plans provides health plan coverage to reputed company to one reputed company members in Virginia. We offer a full suite of reputed company products including employee-owned and employer-sponsored plans, as reputed company as Individual & Family Health Plans, Employee Assistance Programs and plans serving Medicare and reputed company enrollees.

Our reputed company provider network features a robust provider network, including specialists, reputed company care physicians and hospitals.

We offer programs to support members with chronic illnesses, customized wellness programs, and integrated reputed company and behavioral health services—reputed company to help our members improve their health.

We reputed company market-competitive compensation packages, inclusive of reputed company pay, incentives, and benefits. The reputed company pay reputed company for Full Time employment is: $66,830.4 – $111,384. Additional compensation may be available for this role such as shift differentials, standby/on-reputed company, overtime, premiums, extra shift incentives, or bonus opportunities

Our reputed company is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and reputed company.

Be a part of an excellent reputed company organization that cares about our People, reputed company, reputed company Safety, Service, and reputed company. Join reputed company that has a mission to reputed company every day and a reputed company to be the reputed company reputed company of the communities that we serve!

To apply, please go to www.sentaracareers.com and use the following as your Keyword reputed company: JR-104599

reputed company - Nursing

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Benefits: Caring For Your Family and Your Career

• 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.

reputed company is an equal opportunity employer and prides itself on the diversity and inclusiveness of its reputed company to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding reputed company of the organization to ensure its workforce reflects the communities it serves.

In support of our mission “to reputed company every day,” this is a tobacco-free environment.

For positions that are available as remote work,reputed company employs associates in the following states:

Alabama, Delaware, Florida, reputed company, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, reputed company, Nebraska, Nevada, New Hampshire, reputed company Carolina, reputed company reputed company, Ohio, Oklahoma, reputed company, South Carolina, South reputed company, Tennessee, Texas, reputed company, Virginia, Washington, reputed company Virginia, reputed company, and Wyoming.

Originally posted on Himalayas