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ExamWorks स्वास्थ्य सेवा, परामर्श और कानूनी सेवाओं के संगम पर काम करती है। यह दावों और उनसे जुड़ी प्रक्रियाओं के लिए स्वतंत्र चिकित्सा परीक्षण और सहकर्मी समीक्षाएँ प्रदान करती है। इसके कार्यों में बिलों की समीक्षा, मेडिकेयर अनुपालन, चिकित्सा अभिलेखों और दस्तावेज़ों का प्रबंधन तथा अनुपालन ऑडिट भी शामिल हैं।
कंपनी चिकित्सकों के एक व्यापक नेटवर्क को सहयोग देती है और स्वास्थ्य सेवा संगठनों के लिए एंटरप्राइज़ प्लेटफ़ॉर्म तथा कार्यप्रवाह उपकरण विकसित करती है। इसकी टीमें नैदानिक, संचालन, अनुपालन और प्रौद्योगिकी विशेषज्ञता को मिलाकर ग्राहकों को चिकित्सा अभिलेखों और दावों का अधिक सुसंगत और विश्वसनीय ढंग से प्रबंधन करने में सहायता करती हैं।
Utilization Review Nurse Auditor — New Jersey Remote
ExamWorks is hiring a remote Utilization Review Nurse Auditor in New Jersey to assess medical necessity and authorize appropriate care. The role supports accurate, compliant utilization determinations, provider communication, and review documentation.
विवरण
- Conduct high-quality utilization reviews using evidence-based guidelines
- Authorize medically necessary and appropriate care
- Prepare peer review reports, correspondence, addenda, and supplemental reviews
- Collaborate directly with providers to determine the level, intensity, and duration of care
- Assess medical necessity based on care frequency, intensity, and required duration
- Complete reviews according to industry quality standards and required turnaround times
- Stay current on URAC and applicable state and federal regulatory requirements
- Maintain accurate utilization review records in the designated database
- Guide Customer Service Representatives in delivering determination letters on time
- Support the resolution of client complaints and quality assurance matters
- Ensure adherence to ERISA, URAC, and other applicable guidelines
- Provide management with observations about compliance concerns
- Attend company meetings, training sessions, and continuing education activities
- Complete other assigned responsibilities
आवश्यकताएँ
- High school diploma or equivalent is required
- Completion of an accredited nursing program
- An active, unrestricted Registered Nurse, Licensed Practical Nurse, or Licensed Vocational Nurse license is required
- Current coding certification in OASIS, RAC-CT, CCS, CPC, RHIT, or RHIA is required
- CPMA certification is preferred
- Three to five years of direct professional patient-care experience
- Utilization management experience is preferred
- Strong understanding of medical terminology, anatomy and physiology, treatment protocols, medications, and laboratory values
- Typing proficiency of at least 40 words per minute
- Ability to use standard office equipment, including computers, fax machines, copiers, scanners, and telephones
- Working knowledge of Microsoft Suite and multiple software applications
- Ability to protect confidential information
- Ability to work independently, prioritize tasks, and manage time effectively
- Ability to perform under pressure while handling interruptions and unexpected situations
- Ability to follow company policies and procedures
लाभ
- Medical insurance coverage
- Vision insurance coverage
- Dental insurance coverage
- Paid time off
- 401(k) plan
- Continuing education requirements
- Company meetings and training activities
- Fully remote work arrangement
- Competitive benefits
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