Supporting the WISeR Prior Authorization Program, the full-time RN Clinical Quality Reviewer will perform comprehensive clinical reviews, validate documentation accuracy, and assist in physician determination activities, all while working remotely within the US. Key responsibilities Conduct clinical reviews of prior authorization requests in compliance with CMS and internal policies Participate in quality assurance activities to ensure regulatory compliance and identify documentation gaps Collaborate with cross-functional teams to optimize workflows and support operational continuity in a 24/7 environment Required qualifications Active clinical licensure as a Registered Nurse (RN) Experience in reviewing clinical documentation for medical necessity and appropriateness of care Working knowledge of CPT and ICD 10 coding Ability to apply clinical judgment within utilization management or prior authorization workflows Proficiency with healthcare technology platforms and electronic clinical systems
Overview Responsible for the oversight, coordination, and management of the functional and financial outcomes during acute illness requiring hospitalization for patients of the Carle Foundation Hospital. Ensures patients receive proactive initial assessment of needs,...
...Job Description Our client is seeking a Senior Financial Analyst (FP&A) to serve as a key financial business partner supporting business units totaling more than $500M in annual revenue. This individual will own forecasting, budgeting, financial modeling, variance analysis...
...Respond promptly to customer needs, provide excellent customer service, assist patients with follow-up appointments, and fulfill medical documentation requests Balance daily patient charges (cash, check, credit cards) against system reports Complete closing procedures...
...About Us Fanatics is building a leading global digital sports platform. We ignite the passions of global sports fans and maximize... ...For Bachelor's degree in Communications, Journalism, Public Relations, Marketing, Liberal Arts, or a related field required;...
...Health Coach Remote Future is building a personalized guidance system for lifelong health. We help people understand what to do next for their body, goals, and stage of life then support them in turning those decisions into sustained behavior change. By combining...