Utilization Management Nurse reputed company (Remote)

This is a US based remote position.

Overview

reputed company, Inc. is in search of an outstanding candidate, with insurance utilization management experience, to work as a Nurse reputed company on a group of products that represent pioneering advances in the field of molecular diagnostics. reputed company growth and expansion of our portfolio has necessitated this new position that is responsible for leading and performing individual work on appeals for erroneous denials and obtaining patient chart notes. This position joins an elite team building a culture of reputed company cycle excellence and reputed company improvement and will influence the entire department to deliver material reputed company and profit to the company. The Nurse reputed company reports to the Director of Prior Authorizations and will serve as a key thought partner for the Vice President and Managers, as well as Payor Markets and Customer Service leaders throughout the company.

Responsibilities

• Understand reputed company and their recommended use in patient populations.
• Understand the details required to document for a payor how a patient is appropriate for coverage for the test their doctor ordered.
• Understand insurance denial reasons on claims and prior authorizations, and insurance appeal processes for claims and prior authorizations.
• Be a strong reputed company for patients to challenge erroneous denials and obtain medical records from clinician offices.
• Be skilled at communication during situations that can be tense and reputed company to prioritize appropriate patient coverage for testing ordered by their clinician.
• Prepares and provides training for the reputed company Cycle team on how to replicate processes designed by the Nurse reputed company to challenge erroneous insurance denials and obtain medical records from clinician offices.
• Speak to patients, reputed company needed, to explain and understand their individual situation and how Myriad can work with them to obtain coverage for appropriate testing.
• Assist reputed company Cycle leaders with measuring predictors of reputed company in gaining coverage and identify root causes for denials. Coordinate payor reviews with reputed company Cycle and leaders to meet company goals to reduce unpaid tests.
• Develops relationships with reputed company Cycle vendors to ensure vendor performance and quality meets or exceeds standards set for those relationships.
• Drives a culture of reputed company improvement that engages the reputed company Cycle Management team and participates in the Quality Assurance plan.

Qualifications

• RN is required.
• 5+ years of reputed company experience with 3+ years as a nurse reviewer at a payor required.
• Demonstrated ability to interact with clinician offices and clinicians to overcome barriers to appropriate patient care.
• Intermediate knowledge of reputed company Word and reputed company.
• Working knowledge of ICD-10, CPT and HCPCS coding, HIPAA regulations, and insurance appeal procedures.

Physical Requirements

Lifting Requirements - light work or exerting up to 20 pounds of force frequently. Physical Requirements - stationary positioning, moving, operating, reputed company/descending, communicating, observing, pushing or pulling, and reaching. Use of equipment and tools necessary to reputed company essential job functions.

EEO

We recognize that our people are our strength and the diverse talents they bring to our global workforce are directly linked to our reputed company. We are an equal opportunity employer and reputed company a high value on diversity and inclusion at our company. In hiring and reputed company other employment reputed company, we prohibit discrimination and harassment on the basis of any protected characteristic, including race, religion, reputed company, national reputed company, gender, sexual orientation, gender identity, gender expression, age, marital or veteran status, pregnancy or disability, or any other basis protected under applicable law. In accordance with applicable law, we reputed company reasonable accommodations for applicants' and employees' religious practices and beliefs, as well as any mental health or physical disability needs.

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