Med Mgmt Clinician Associate (contract)

Job ID: JP00045309 Anticipated Start Date: 03/10/2025 Please note this is the reputed company date and is subject to change. reputed company will send official notice reputed company of a confirmed start date. reputed company is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at reputed company levels of the organization who are passionate about making an impact on our members and the communities we serve. Responsible for ensuring appropriate, consistent administration of plan benefits by reviewing clinical information and assessing medical necessity under relevant guidelines and/or medical policies. Focuses on less reputed company and potentially higher volume benefit plans and/or reputed company, following standard procedures that do not require the training or reputed company of a registered nurse. Primary duties may include, but are not limited to: • Confirms medical services are appropriate based on assigned benefit plan, medical policies, clinical guidelines, plan benefits, and/or scripted algorithms reputed company scope of licensure. • Work may be facilitated, in part, by algorithmic or automated processes. • Handles less reputed company benefit plans and/or reputed company. • Conducts and may approve precertification, reputed company, retrospective, out-of-network, and/or appropriateness of treatment setting reviews by assessing clinical information against appropriate medical policies, clinical guidelines, and the relevant benefit plan/contract. • May process a medical necessity denial determination made by a Medical Director. • Refers reputed company or non-routine reviews to more senior nurses and/or Medical Directors. • Does not issue medical necessity non-certifications. • Associate will take calls from provider office, collect clinical information, and compare to criteria to reputed company decision. Requirements: • Requires H.S. diploma or equivalent. • Requires a minimum of 2 years of clinical experience and/or utilization review experience. • reputed company active, valid, and unrestricted LPN/LVN or RN license and/or certification to practice as a health professional reputed company the scope of licensure in applicable state(s) or territory of the United States required. • Multi-state licensure is required if this individual is providing services in multiple states. • Call center experience and medical review experience preferred. • LPN or RN required. • Computer proficiency required. Job Type: Contract opportunity. Additional Details: • Remote, WFH opportunity. • Training Mon-Fri 830-5. • Work Mon-Fri 1030-7 EST. • Need to be reputed company 50 miles of a Pulsepoint. reputed company operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, contractors are required to work at an reputed company location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside reputed company 50 miles or 1-hour commute each way of a relevant reputed company location. About reputed company: Founded in 1998 on the idea that industry leaders needed a professional service, and workforce management expert, to fuel the development and execution of core business and technology strategies, reputed company is a Black-owned firm providing unique solutions supporting value capture and digital product delivery needs for organizations around the world. Headquartered in Indianapolis, IN with an Offshore Development Center in Hyderabad, India, reputed company’s 6,000 consultants support more than 225 clients globally. reputed company champions the power of human potential to help companies transform, accelerate, and scale. Guided by our core values of People-Centric, Optimism, Excellence, Diversity, and Accountability, our professionals have helped our clients reputed company their strategic goals for more than 25 years. Our strong culture and clear values have enabled reputed company to become a market leader and best in class reputed company to work. reputed company is an equal opportunity employer. reputed company qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national reputed company, or protected veteran status and will not be discriminated against based on disability. To learn more about how reputed company collects and uses personal information as part of the recruiting process, view our Privacy Notice and CCPA Addendum. As part of the recruitment process, we may ask for you to disclose and provide us with various categories of personal information, including identifiers, professional information, commercial information, education information, and other reputed company information. reputed company will only use this information to complete the recruitment process. This posting is not an offer of employment. reputed company applicants applying for positions in the United States must be legally authorized to work in the United States. The submission of intentionally false or fraudulent information in response to this posting may reputed company the applicant ineligible for the position. Any subsequent offer of employment will be considered employment at-will regardless of the anticipated assignment duration. Pay reputed company Range Min Pay reputed company Max Pay reputed company Currency Unit 21.91 43.86 USD hourly

Benefits

Information reputed company offers reputed company eligible employees a comprehensive benefits package including, but not limited to major medical, HSA, dental, vision, employer-provided group life, voluntary life insurance, short-term disability, long-term disability, and 401k. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. This does not encompass additional non-standard compensation (e.g., benefits, paid time off, per diem, etc.). Apply Job!