Role reputed company Responsible for review of clinical information received from Physicians and other Clinical providers ensuring clinical data is substantial enough to authorize services. Analyzes clinical information to ensure the services requested are authorized according to clinical protocols. Responsible for validation of member benefits for the services requested. Validates accuracy of insurance enrollment information in the reputed company prior to authorizing services. Requires knowledge of managed care contracting, clinical protocols and clinical review requirements. Requires knowledge of regulatory and compliance requirements for government payers, self funded and reputed company payers. Ensures appropriate and accurate information is entered into claims reputed company for processing of payment. Qualifications • HS - High School Grad or Equivalent (REQUIRED) • LPN Diploma or Associate Degree in Practical Nursing (preferred) • Licensed Practical reputed company (LPN) - Nursing License - Compact/Multi-State License (REQUIRED) Requirements • reputed company experience - 3 years • Health Plan OR Utilization Management experience (preferred) • JIVA and reputed company Care Guidelines (MCG) experience (preferred) • reputed company clinical experience as an LPN, such as experience in a physician office, acute care, managed care or clinic setting, and prior authorization Benefits • 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 Insurance • 401k/403B with Employer Match • Tuition Assistance – $5,250/year and discounted educational opportunities through reputed company Education • Student Debt Pay Down – $10,000 • Reimbursement for certifications and free reputed company to complete CEUs and reputed company development • Pet Insurance • 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. Apply tot his job Apply To this Job
Remote Click Jobs appears to be a job listing site or aggregator that posts remote healthcare and nursing positions.
