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ExamWorks
ExamWorks
5.001 – 10.000 Angajați
Asistență medicalăConsultanțăJuridic

ExamWorks activează la intersecția dintre domeniul medical, consultanță și servicii juridice, oferind examinări medicale independente și evaluări realizate de specialiști de același nivel pentru dosare de despăgubire și procese conexe. Activitatea sa include, de asemenea, verificarea facturilor, conformitatea cu cerințele Medicare, gestionarea dosarelor medicale și a documentelor, precum și audituri de conformitate.

Compania sprijină o rețea extinsă de medici și dezvoltă platforme pentru organizații și instrumente de gestionare a fluxurilor de lucru pentru organizații din domeniul medical. Echipele sale combină expertiza clinică, operațională, de conformitate și tehnologică pentru a ajuta clienții să gestioneze dosarele medicale și cererile de despăgubire cu mai multă consecvență și fiabilitate.

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Locurile de muncă ale companiei

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.

USStatele Unite ale AmericiiNJNew Jersey
33 $ – 46 $ / oră
RemoteNormă întreagăNivel mediuSeniorLimbă Obligatorie: englezăAuditor

Descriere

  • 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

Cerințe

  • 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

Beneficii

  • 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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