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ExamWorks
ExamWorks
5 001 – 10 000 Darbuotojai
KonsultavimasSveikatos priežiūraTeisė

„ExamWorks“ veikia sveikatos priežiūros, konsultavimo ir teisinių paslaugų sankirtoje, teikdama nepriklausomas medicinines ekspertizes ir tarpusavio vertinimus, skirtus žalų reikalavimams bei susijusiems procesams. Įmonės veikla taip pat apima sąskaitų tikrinimą, „Medicare“ reikalavimų laikymąsi, medicininių įrašų ir dokumentų valdymą bei atitikties auditą.

Įmonė palaiko platų gydytojų tinklą ir kuria sveikatos priežiūros organizacijoms skirtas įmonių platformas bei darbo srautų valdymo priemones. Jos komandos sujungia klinikinę, operacinę, atitikties ir technologijų kompetenciją, kad padėtų klientams nuosekliau ir patikimiau valdyti medicininius įrašus bei žalų reikalavimus.

LinkedIn
Darbai įmonėje

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.

USJungtinės ValstijosNJNaujasis Džersis
33 $ – 46 $ / valanda
NuotolinisVisas etatasVidutinis lygisVyresnysis specialistasPrivaloma Kalba: anglųAuditorius

Aprašymas

  • 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

Reikalavimai

  • 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

Privalumai

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

Susiję darbai

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GrožisPrekyvietėSaaS
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Red Hat
H1B vizos rėmėjasDebesijaĮmonė
ILIzraelisDarbas vietojeVisas etatasVidutinis lygisVyresnysis specialistasPrivaloma Kalba: anglųPrivaloma Kalba: hebrajųDebesijos inžinierius
AnsibleAtvirasis kodasAWSAzureDebesijaDockerKubernetesLinuxMikropaslaugosOpenShift

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LogistikaSveikatos priežiūraSvetingumo sektorius
ARArgentinaBOBolivijaBRBrazilijaCLČilėCOKolumbijaCRKosta RikaCUKubaDODominikos RespublikaECEkvadorasGTGvatemalaHNHondūrasHTHaitisMXMeksikaNINikaragvaPAPanamaPEPeruPRPuerto RikasPYParagvajusSVSalvadorasUYUrugvajusVEVenesuelaNuotolinisVisas etatasJaunesnysis specialistasDiplomas nebūtinasPrivaloma Kalba: anglųPrivaloma Kalba: ispanųVertėjas

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RecruitGo

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RecruitGo
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KonsultavimasLogistikaRinkodara
PHFilipinai
45 000 ₱ / mėnuo
NuotolinisVisas etatasJaunesnysis specialistasVidutinis lygisDiplomas nebūtinasPrivaloma Kalba: anglųVadovo asistentas

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