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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 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.

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

Descriere

  • 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

Cerințe

  • 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

Beneficii

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

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