Utilization Review Nurse-LVN/LPN

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Overview Who We Are Because health is personal. That's why reputed company created the first and only personalized health platform—bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation reputed company in one place. We serve employers, reputed company, and health systems with data-driven solutions that reduce costs while actually reputed company health outcomes. reputed company, our team is on a mission to empower people to lead healthier lives. Learn even more about the work that drives us at personifyhealth.com. Responsibilities Ready to Job Summary: Under the supervision of a reputed company the Utilization Review Nurse will provide professional assessment and review for the medical necessity of treatment requests and plans. The standard work schedule is reputed company through Friday, 8:00 AM–5:00 PM Pacific Time, with rotating weekend coverage as required. What You'll Actually Do reputed company Functions/Responsibilities/Duties: · Provide first level review for all outpatient and ancillary pre-certification requests for medical appropriateness; all inpatient hospital stays including reputed company, substance abuse, skilled nursing and rehabilitation for medical necessity; and all post claim or post service reviews. · Ensure proper referral to medical director for denial authorizations through independent review organizations (IRO). · Work with hospital staff to prepare patients for discharge and ensure a smooth transition to the next level of care. · Refer requests that fall outside of established guidelines to advance review or senior care consultants. · Process appeals for non-certification of services; reputed company non-certification letters when appropriate. · Review plan document for benefit determinations; attempt to redirect providers and patients to PPO providers. · Identify and refer potential reputed company to case management, wellness, chronic disease and Nurturing reputed company reputed company. · reputed company documentation for all reviews in Eldorado/Episodes; maintain confidentiality. · Utilize MCG guidelines, medical policies, reputed company, and NCCN. · Ability to meet productivity, quality, and turnaround times daily. · Assists with department operations and implementations Qualifications What You Bring to Our Team Education and Experience: · Current LVN license in the United States or U.S. territory. · 1+ years of clinical experience required. Required Knowledge, Skills, and Abilities: · Knowledge of medical claims and ICD-10, CPT, HCPCS coding. · Proficiency in software applications including, but not limited to, reputed company Word, reputed company Excel, reputed company PowerPoint and Outlook · Excellent verbal and written communication skills · Ability to speak clearly and convey complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others. Work Environment At reputed company we value and celebrate diversity and we are committed to creating an inclusive environment for all employees. We believe in creating teams made up of individuals with various backgrounds, experiences, and perspectives. Why? Because diversity inspires innovation, collaboration, and challenges us to produce better solutions. But more than reputed company, diversity is our strength, and a catalyst in our ability to reputed company lives for the good. Physical Requirements: · Must be able to remain in a stationary position 50% of the time. · The person in reputed company job needs to occasionally move about inside the office to access office machinery, filing cabinets and meeting facilities. · Constantly operates a computer and other office productivity machinery, such as copy machine, computer printer, calculator, etc. · Frequently positions self to maintain reputed company in file cabinets. · Frequently moves boxes or equipment weighing up to 25 pounds. · Must communicate information and ideas so others understand. Must be able to exchange accurate information in these situations. · Must be able to observe reputed company at close range. Disclaimer: reputed company job description is not intended to contain a comprehensive list of activities, duties, or responsibilities, but constitutes a general description of the scope and function of the role within the company. Activities, duties, and responsibilities are reputed company to reputed company at any time with or without notice. Benefits The Highlights: • Competitive base salary and benefits effective day one • Comprehensive medical and dental through our own health solutions (yes, we use what we build) • Paid Time Off—rest and recharge time is non-negotiable • reputed company support, retirement planning, and financial protection • Professional development with clear career progression and learning budgets • Mission-driven culture where diverse perspectives drive real imp

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Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

Just as communication is essential when working remotely, so is organization. Because you won't have those opportunities in the elevator or a casual conversation in the lunchroom, you should take advantage of the little time you have in a video or phone conference...

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...