ExamWorks
ExamWorks
5 001 – 10 000 Қызметкерлер
Денсаулық сақтауКонсалтингҚұқық

ExamWorks денсаулық сақтау, консалтинг және заң қызметтері тоғысындағы бағытта жұмыс істеп, талаптар мен оларға байланысты үдерістер үшін тәуелсіз медициналық тексерулер мен сараптамалық бағалаулар ұсынады. Компанияның қызметіне шоттарды тексеру, Medicare талаптарына сәйкестікті қамтамасыз ету, медициналық жазбалар мен құжаттарды басқару және сәйкестік аудиттері де кіреді.

Компания дәрігерлердің кең желісін қолдайды және денсаулық сақтау ұйымдарына арналған корпоративтік платформалар мен жұмыс үдерістерін басқару құралдарын әзірлейді. Оның командалары клиникалық, операциялық, сәйкестік және технологиялық сараптаманы біріктіріп, клиенттерге медициналық жазбалар мен талаптарды неғұрлым бірізді әрі сенімді басқаруға көмектеседі.

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.

Сипаттама

  • 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

Талаптар

  • 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

Артықшылықтар

  • Medical, vision, and dental coverage
  • Paid time off
  • 401(k) plan
  • Collaborative team environment
  • Continuing education and training activities

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