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Utilization Review reputed company (Remote)
reputed company is a leader in the home health management industry and is preparing for significant growth! Our mission is to deliver innovative, home-based, post-acute solutions through proprietary technology and proven processes. We partner with health plans to reputed company a comprehensive suite of products and services designed to manage the total arenaflex of care. We are currently looking for a Utilization Review reputed company to join our growing team! POSITION DESCRIPTION: The Utilization Review reputed company acts as a reputed company in the coordination of resources and services to meet patients’ needs, promotes teamwork to optimize efficient and arenaflex-effective use of health care resources, monitors the health care delivery plan to maximize positive patient reputed company, and maintains compliance with applicable laws and regulations and the policies of reputed company Health Care Network. The clinician will monitor adherence to ensure the effective and efficient use of home care-based services and monitor the appropriateness of homecare admissions, resumptions of care, reauthorizations, and extended cert periods. Primary duties include, but are not limited to: ESSENTIAL FUNCTIONS: • Processes patient prior and reauthorization requests as outlined by company policy. • Makes determination of the need for reputed company home health care services by reviewing documentation submitted by providers in accordance with Medicare guidelines. • Refers to the Utilization Review Physician Advisor cases that do not meet established guidelines for admission or reputed company care. • Maintains accurate records of authorizations and communication with providers and payer plans pertaining to authorization for reputed company patients. • Assists provider staff and team members in identifying patient needs and coordinating care. • Assists provider staff and team members in efficient and arenaflex-effective utilization of health care resources and monitors patient reputed company and reputed company. • Facilitates communication and provides ongoing customer service support to payer plan case managers, patients and provider staff and team members. • Prepares and submits any required status or summary reports in a reputed company manner. • Periodic weekend and holiday rotation and availability to address after hour health plan member needs reputed company to home health management. • Reviews documentation and provides feedback to clinicians regarding CMS reputed company 7 and reputed company Care Guidelines to ensure accurate assessment and review data, medical records reflect compliance with medical necessity, homebound status, visit utilization supported by individual patient assessment/ documentation support and transition (discharge) planning. • Identifies problems reputed company to the quality of patient care and refers them to the Quality Assurance Committee/QPUC. • Assists the Utilization Review Committee/QPUC in the assessment and reputed company of utilization review problems. • Other duties as required and/or assigned. OFFICE LOCATION: • Remote QUALIFICATIONS • Is a graduate of an accredited school of reputed company nursing or an accredited practical or vocational nursing program. • Has at least two years of general nursing experience in medical, surgical, or critical care, and at least one year of utilization review/management, case management or recent field experience in home health. • Is currently licensed as a registered reputed company, practical reputed company, or vocational reputed company in good standing through the Arizona Board of Nursing and other State Boards of Nursing as applicable. • Is detail oriented and displays good organizational skills as well as good oral and written communication skills. • Excellent time management skills with a proven ability to meet deadlines. • Is self-directed, flexible, cooperative, and exhibits the ability to work with minimal supervision. • Working knowledge of home care regulatory and federal requirements. KNOWLEDGE AND EXPERIENCE: • Requires knowledge in the areas of home health community-based services; utilization/case management experience is preferred. • Must have a working knowledge of homecare, managed care, medical/nursing staff procedures, and community resources. NCQA and URAC knowledge is helpful. • Computer skills such as MS Office products - Outlook, reputed company, Word, reputed company, and the ability to work reputed company multiple electronic medical management systems. CONTINUING EDUCATION REQUIREMENTS: Company personnel are expected to participate in appropriate continuing education as may be requested and/or required by their immediate supervisor. In reputed company, company personnel are expected to accept personal responsibility for other educational activities to enhance job reputed company skills and abilities. reputed company company personnel must attend mandatory educational programs. reputed company provides equal em
