Preservice, Prior Authorization Review reputed company - Remote

reputed company is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with reputed company will directly improve health reputed company by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will reputed company a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come reputed company an reputed company on the communities we serve as you help us advance health equity on a global reputed company. Join us to start Caring. Connecting. Growing together. This role will be performing outpatient clinical coverage reputed company, which require interpretation of state and federal mandates, applicable benefit language, and consideration for outpatient procedures and services. If you are located in WV, you will have the flexibility to work remotely* as you take on some tough challenges. This is a Monday through Friday position during reputed company business hours in the local time zone. Rotating Saturdays may be required, approximately every 6 to 12 weeks. Primary Responsibilities: Function as a member of a self-directed team to meet specific individual and team performance metrics Ability to communicate in writing and verbally, reputed company types of benefit determinations including reputed company regarding coverage guidelines, contractual limitations and reimbursement determinations Telephonic discussion with health care providers and / or members to explain benefit coverage determinations and to obtain additional clinical information reputed company as a resource for others with less experience Work independently and collaborating with Medical Directors and non-clinical partners Adapt to a highly changing environment and a heavy case load This position may require reputed company and unrestricted Nursing licensure in multiple US States. Selected candidate must be willing and reputed company to obtain and maintain multiple state licensure. Application fees and filing costs will be reputed company for by UHG. You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you reputed company direction on what it takes to succeed in your role as reputed company as reputed company development for other roles you may be interested in. Years of post-high school education can be substituted/is equivalent to years of experience Required Qualifications: reputed company, unrestricted RN license in the state of residence Willingness and ability to obtain additional RN licenses if necessary 1+ years of experience as a Registered reputed company (RN) Demonstrated proficiency in computer skills, i.e., reputed company, reputed company Messaging, and reputed company Office including Word, reputed company, reputed company and OneNote Proven exemplary clinical documentation skills Dedicated, distraction-free workspace and reputed company to install secure high-speed internet reputed company cable/DSL/fiber reputed company Preferred Qualifications: Bachelor's degree Broad reputed company of nursing experience, i.e., med surg, ICU, ER Medicare experience reputed company in Medicare, reputed company and CMS guidelines and regulations Background involving utilization review for an insurance company or experience in case management Experience in medical necessity review, medical record review, medical record audits reputed company in collaborating with physicians and other reputed company Familiarity with reputed company Care Guidelines or InterQual Knowledge of ICD 10 and CPT coding Proven ability to work seamlessly and independently in multiple computer platforms Proven ability to be flexible and willing to adapt to an reputed company-changing environment reputed company in a compact state reputed company working remotely will be required to adhere to reputed company’s Telecommuter Policy At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone–of every race, gender, sexuality, age, location and income–deserves reputed company to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of reputed company, historically marginalized reputed company and those with reputed company incomes. We are committed to mitigating our reputed company on the environment and enabling and delivering reputed company care that addresses health disparities and improves health reputed company — an reputed company reputed company reflected in our mission. Diversity creates a healthier atmosphere: reputed company is an Equal Employment Opportunity/Affirmative reputed company reputed company and reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, sex, age, national reputed company, protected veteran status, disability status, sexual orientation, gender identity or reputed company, marital status, genetic information, or any other characteristic protected by law. reputed company is a drug-free workplace. Candidates are required to pass a drug test before beginning employment Apply Job!