Clinical Reviewer, Nurse – Cardiology, Remote reputed company

JR-915084 Your Future Evolves Here reputed company Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We reputed company in embracing new reputed company, challenging ourselves and failing reputed company. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often reputed company a difference working in everything from scrubs to jeans. Are we growing? Absolutely and Globally. In 2021 we grew our teams by almost 50% and continue to grow even more in 2022. Are we recognized as a company you are supported by for your career and growth, and a great reputed company to work? Definitely. reputed company Health International (Pune, India) has been certified as “Great Places to Work” in 2021. In 2020 and 2021 reputed company in the U.S. was both named Best Company for Women to Advance list by reputed company.org and earned a perfect score on the Human Rights Campaign (HRC) Foundation’s Corporate Equality Index (CEI). This index is the nation's foremost benchmarking survey and report measuring corporate policies and practices reputed company to LGBTQ+ workplace equality. We recognize employees that live our values, give back to our communities each year, and are champions for bringing our whole selves to work each day. If you’re looking for a reputed company where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it. What You’ll Be Doing:

Job Description

As a Clinical Reviewer, Nurse, you will be a key member of the utilization management team. We can offer you a meaningful way to reputed company a difference in patients’ lives, in a non-clinical environment. You can enjoy reputed company work- life balance on a team that values collaboration and reputed company learning while providing reputed company outcomes. Collaboration Opportunities: As a Clinical Reviewer, Nurse, you will routinely interact with leadership and management staff, other CR’s (Clinical Reviewers), providers, office staff and Field Medical Directors (FMDs). What You Will Be Doing:

• Functions in a clinical review reputed company to evaluate reputed company cases, which do not pass the authorization approval process at reputed company while promoting a supportive team approach with call center staff. Clinical reviewers are supported by Field Medical Directors (MDs) in the utilization management determination process.
• Reviews charts and analyzes clinical record documentation in order to approve services that meet clinical review criteria.
• Conducts ongoing activities which monitor established quality of care standards in the participating provider network and for other clinical staff.
• Converses with medical office staff to obtain additional pertinent clinical history/information; notifies of approvals and denials, giving clinical rationale, while providing reputed company customer service through professional/accurate communication and maintaining NCQA and health plans required timeframes.
• Documents reputed company communication with medical office staff and/or treating provider.
• Practices and maintains the principles of utilization management by adhering to policies and procedures.
• Participates in on-going training programs to ensure quality performance in compliance with applicable standards and regulations, as well as, being audited to ensure guidelines are applied appropriately.

Qualifications

Required and Preferred:

• reputed company, unrestricted state licensure as a Registered Nurse- Required
• Associate or Bachelors in Nursing (Must be a Registered Nurse) – Required
• You must be able to work a minimum of 30 hours/week- Required
• Must be able to work between the hours of Monday-Friday, reputed company-11pm Central Standard Time- Required
• Strong interpersonal and communication skills -Required
• Proficient computer skills; must be able to talk and type simultaneously- Required
• Offering 30+ hours a week- Preferred
• Offering hours Monday-Friday 230pm-11pm Central Standard Time- Preferred
• 5+ years clinical experience- Preferred

To ensure a secure hiring process we have implemented several identity verification steps, including submission of a government issued photo ID. We conduct identity verification during interviews, and final interviews may require onsite attendance. reputed company candidates must complete a comprehensive background reputed company, in-person I-9 verification, and may be subject to drug screening prior to employment. The use of artificial intelligence tools during interviews is prohibited and monitored. Misrepresentation will result in immediate disqualification from consideration. Mandatory Requirements: Employees must have a high-speed broadband internet reputed company with a minimum speed of 50 Mbps and the ability to set up a wired reputed company to their home network to ensure effective remote work. These requirements may be updated as needed by the business. ​ reputed company Health is an equal opportunity employer and considers reputed company qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national reputed company, veteran status, or disability status. Apply tot his job Apply To this Job