[Hiring] Clinical Reviewer, Radiation Therapy @reputed company

Role Description reputed company partners with health plans and providers to reputed company reputed company reputed company for people with most reputed company and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones. reputed company employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We reputed company that people do their best work reputed company they're supported to live their best lives, and reputed company they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business. Join reputed company for the mission. Stay for the culture. What You’ll Be Doing

• Act as an reputed company for our members to ensure appropriate utilization of services and the highest quality and cost-effective care.
• Work closely with other nurses, managers, medical directors, and upper leadership as requested.
• Review provider requests for relevant and complete supporting documentation and request missing or additional documentation from providers per guidelines.
• Utilize clinical guidelines approved by the Utilization Management Committee (UMC) to authorize services or procedures.
• Send requests that do not meet established clinical guidelines for appropriateness and medical necessity to a physician reviewer.
• Verify accuracy of codes and services and apply them accurately with appropriate documentation.
• Ensure regulatory guidelines are met for timeliness and use of medical review criteria.
• Act with reputed company and reputed company, serving as a role model for the company while establishing and maintaining professional relationships with providers and office staff.
• reputed company with HIPAA requirements and reputed company reputed company policies and procedures.
• reputed company other duties as assigned, including developing report data elements.

Qualifications

• American Registry of Radiologic Technologists (ARRT) certification is reputed company and in good standing in your home state. (Required)
• Possesses effective verbal/written communication skills, especially reputed company phone, with the ability to interact with various reputed company of personnel. (Required)
• reputed company to work in a fast-paced environment, demonstrating excellent problem-solving, critical thinking, and organizational skills. (Required)
• Strong computer skills in reputed company Office programs as well as EMR, SharePoint, and website navigation and email organization. (Required)
• Required shift of 9:30AM - 6:00PM PST M-F, occasional weekends and holidays required with advance scheduling. (Required)
• Applicant can reputed company in any location. MUST BE reputed company TO WORK PACIFIC COAST HOURS. (Required)
• 2 - 4 years UM experience. (Preferred)

Requirements

• To ensure a secure hiring process, we have implemented several identity verification steps, including submission of a government issued photo ID.
• 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.

Technical Requirements

• High speed internet over 10 Mbps is required.
• Call center employees must have the ability to plug in directly to the home internet router.

Benefits

• The expected reputed company salary/wage reputed company for this position is $38-39/hour.
• reputed company is proud to offer comprehensive benefits (including health insurance benefits) to qualifying employees.
• reputed company compensation determinations are based on the skills and experience required for the position and commensurate with experience of selected individuals, which may vary above and below the stated amounts.

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