Job Information
Genex Services, LLC. Utilization Reviewer 2 in Wayne, Pennsylvania
Genex Service LLC Utilization Reviewer 2 US--Remote Job ID: 24-16838 Type: Regular Full-Time # of Openings: 1 Category: Medical Services & Support Mitchell International, Inc. Overview
The Enlyte Family of Businesses
Mitchell | Genex | Coventry
Enlyte is the parent brand of Mitchell, Genex and Coventry, an organization unlike any other in the Property & Casualty industry, bringing together three great businesses with a shared vision of using technology innovation, clinical services and network solutions to help our customers and the people they serve. Our suite of products and services enable our employees to help people recover from challenging life events, while providing opportunities for meaningful impact and career growth.
Responsibilities
We are seeking a qualified Utilization Reviewer who can work remotely from home. The ideal candidate performs utilization review on auto casualty related retrospective treatment referrals. The ideal candidate will play a crucial role in assessing and ensuring the appropriateness of medical treatment plans, contributing to effective claims management and optimal patient outcomes.
- * Uses solid clinical judgment to ensure treatment approved is related and medically necessary.
- * Collaborates with healthcare providers, claims adjusters, and other stakeholders to gather relevant information for comprehensive assessments.
- * Evaluates medical documentation to ensure compliance with industry standards and regulatory requirements.
- * Communicates findings clearly and concisely through written reports and verbal discussions.
- * Stays up-to-date on industry regulations, medical advancements, and best practices to enhance the quality of reviews.
- * Participates in team meetings and contributes to the continuous improvement of utilization review processes.
Qualifications
Minimum Education: Associates degree
Required Skills and Experience:
- * Registered Nurse (RN) or LVN with a valid license in the state of New Jersey.
- * Minimum of 2 years of clinical experience; or an advanced degree without experience.
- * Knowledge of medical terminology, treatment modalities, and healthcare guidelines.
- * Analytical and critical thinking skills for effective decision-making.
- * Strong communication and interpersonal skills to liaise with diverse stakeholders.
- * Ability to work independently and collaboratively within a team environment.
- * Detail-oriented with strong organizational skills to manage multiple cases efficiently.
* Familiarity with relevant software and tools used in healthcare.
Desired Skills and Experience:
- * Prior review experience in healthcare, insurance, utilization management, quality assurance, or other applicable capacity.
- * Prior experience in auto liability.
Benefits We're committed to supporting your Equal Employment Opportunity/M/F/disability/protected veteran status PI240615139