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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 seeking a remote Utilization Review Nurse Auditor in New Jersey to assess medical necessity, regulatory compliance, and care appropriateness. The role conducts evidence-based reviews and coordinates determination workflows.
विवरण
- Conduct quality utilization reviews and approve care that meets evidence-based medical necessity criteria
- Prepare peer review reports, correspondence, addenda, and supplemental reviews
- Collaborate with providers to assess the level, intensity, and duration of care
- Record findings and evaluate medical necessity across care frequency, intensity, and length
- Complete reviews within applicable industry, client, federal, state, and URAC turnaround standards
- Stay current with URAC and other relevant regulatory requirements
- Keep utilization review records accurate in the designated database
- Coordinate Customer Service Representatives to support prompt delivery of determination letters
- Support the resolution of client complaints and quality assurance matters
- Advise management about potential compliance concerns
- Attend company meetings, training sessions, and continuing education activities
- Handle other duties as assigned
आवश्यकताएँ
- High school diploma or equivalent
- Graduation from an accredited nursing program
- Active, unrestricted RN, LPN, or LVN license
- Current OASIS, RAC-CT, CCS, CPC, RHIT, or RHIA coding certification
- CPMA certification is preferred
- Three to five years of direct professional patient-care experience
- Prior utilization management experience is preferred
- Strong understanding of medical terminology, anatomy and physiology, treatment protocols, medications, and laboratory values
- Typing speed of at least 40 words per minute
- Ability to use computers, fax machines, copiers, scanners, and telephones
- Familiarity with multiple software applications, including Microsoft Suite
- Ability to protect confidential information
- Ability to work independently, prioritize tasks, and manage time effectively
- Ability to follow company policies and procedures
लाभ
- Medical, vision, and dental coverage
- Paid time off
- 401(k) plan
- Collaborative team environment
- Continuing education and training activities
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