- Remote, United States
- Remote
Perform quality utilization review services and approve medically necessary care for clients, ensuring compliance with regulations and standards.
Responsibilities
- Perform quality utilization review through evidence-based guidelines
- Work directly with providers to identify level, intensity and duration of care
- Document findings and evaluate medical necessity
- Ensure reviews meet industry standards and turnaround times
- Maintain knowledge of URAC and state/federal regulations
Requirements
- CPC certification required within 6 months of hire