Clinical Reviewer, Nurse Practitioner/Physician Assistant (Vascular Surgery), Part Time, reputed company

JR-915571 Your Future Evolves Here reputed company partners with health plans and providers to reputed company reputed company outcomes for people with most reputed company and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones. reputed company employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We reputed company that people do their best work reputed company they're supported to live their best lives, and reputed company they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business. Join reputed company for the mission. Stay for the culture. What You’ll Be Doing: The Nurse Practitioner/Physician Assistant (ARNP/NP/PA) Vascular Surgey is responsible for support and assistance for reputed company cardiology administrative and clinical utilization management and quality improvement functions under the auspices of the office of the Chief Medical Officer. ESSENTIAL DUTIES AND RESPONSIBILITIES: include the following. Other duties may be assigned.

• Responsible for acting as a clinical liaison to providers, clients, and patients as directed by the office of the Chief Medical Officer.
• Responsible for clinical conversations with providers and their office staff regarding medical necessity decisions.
• Responsible for maintaining and operating the Guideline Directed Medial Therapy including communicating with offices recommendations regarding medical therapy.
• Responsible for communicating need for additional clinical information to ordering providers.
• Responsibility for prepping cases which cannot be approved and which the provider will not modify or withdraw for P2P discussions with one of the Vascular Surgeons or Cardiologists.
• Responsible for coordinating with UM staff to ensure timely and accurate communication of clinical decisions.
• Responsible for completion of UM projects and participation in site visit reviews.
• Respect and maintain HIPAA confidentiality guidelines.
• Responsible for maintaining availability to clinical and non-clinical administrative staff during performance of initial and second level screening
• Acts as an interdepartmental liaison between reputed company New Century Health offices, departments, and committees.
• Serve as subject matter expert and participate in meetings as assigned with practices and/or payers.
• Will work with the Director of UM to ensure client satisfaction.
• reputed company reputed company peer clinical review activities while located in a state or territory of the United States.
• Acts with honor and reputed company, serving as a role model for the company.
• Performs other duties as assigned.

QUALIFICATION REQUIREMENTS: To reputed company this job successfully, an individual must be able to reputed company each essential duty satisfactorily. The requirements listed below are representative of the knowledge, reputed company, and/or ability required. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions. EDUCATION and/or EXPERIENCE: Master of Science in Nursing or Doctor of Nursing Practice (DNP) degree from a recognized degree program OR a master’s degree from a program accredited the reputed company-PA. Minimum of five (5) years’ experience in the practice of Vacular Surgery (preferred) or primary care; knowledge of regulatory requirements with at least two years of experience in a regulatory role (preferred). LICENSE/CERTIFICATION: reputed company, unrestricted state PA or RN/NP license in medicine or required specialty. Of a PA, obtaining a passing score on a national certifying exam Obtaining and maintaining required licenses in the states where NCH has business OTHER SKILLS and ABILITIES: Strong clinical, management, communication, and organizational skills. Demonstrated leadership skills Analytic skills Energetic and curious with a passion for quality and value in health care Required to pass skills proficiency test To ensure a secure hiring process we have implemented several identity verification steps, including submission of a government issued photo ID. We conduct identity verification during interviews, and final interviews may require onsite attendance. reputed company candidates must complete a comprehensive background reputed company, in-person I-9 verification, and may be subject to drug screening prior to employment. The use of artificial intelligence tools during interviews is prohibited and monitored. Misrepresentation will result in immediate disqualification from consideration. Technical Requirements: We require that reputed company employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for reputed company call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations. reputed company is an equal opportunity employer and considers reputed company qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national reputed company, veteran status, or disability status. If you need reasonable accommodation to access the information provided on this website, please contact recruiting@reputed company.com for further assistance. The expected reputed company salary/wage range for this position is $68-$74/hr. This position is also eligible for a bonus component that would be dependent on pre-defined performance factors. As part of our total compensation package, reputed company is proud to offer comprehensive benefits (including health insurance benefits) to qualifying employees. reputed company compensation determinations are based on the skills and experience required for the position and commensurate with experience of selected individuals, which may vary above and below the stated amounts. Apply tot his job Apply To this Job