Data Entry Question and Answer

$150 $49

Remote Question and Answer

$150 $49

Virtual Assistant Question and Answer

$150 $49

Content Moderator Question and Answer

$150 $49

Customer Service Question and Answer

$150 $49

Video Game Tester Question and Answer

$150 $49

Utilization Management

Other Jobs To Apply

No other job posts for this day.

Alignment Health is seeking a remote Utilization Management (UM) Nurse - Pre-service to join the UM team. This role involves reviewing requests for pre-certification for inpatient and outpatient services, collaborating with providers and medical directors to ensure timely processing of referrals for the best medical outcomes at the most cost-efficient rate. General Duties / Responsibilities: Review pre-certification requests for medical necessity and refer to the Medical Director when necessary. Utilize CMS guidelines and Milliman Care Guidelines (MCG) for referral determinations. Maintain goals for turnaround time (TAT) for referral processing. Initiate Single Service Agreements (SSA) when services required are not available in-network. Maintain professional rapport with providers, physicians, support staff, and patients for efficient pre-certification referral processing. Verify eligibility and benefit coverage for requested services. Verify accuracy of ICD-10 and CPT coding in processing pre-certification requests. Request medical records and documentation from providers when necessary. Assist in reviewing and responding to appeal and grievance cases. Maintain documentation of expedited requests. Minimum Qualifications & Skills: 3+ years' nursing experience in a clinical setting. 1+ year UM experience with pre-service. 1+ year experience in managed care (Medicaid and/or Medicare). 1+ year experience applying UM criteria (CMS guidelines, MCG). Familiarity with medical terminology, ICD-10, CPT codes, and referral systems. Proficiency in Word, Excel, Microsoft Outlook. Education & Licensure: Required: High School Diploma or GED. Preferred: Associate's or Bachelor's degree in Nursing. Must have active LVN / RN license in North Carolina (Compact), with the ability to obtain additional state licenses (California, Nevada, Arizona, Texas). Preferred Qualifications: CPHQ, ABQAURP, or Six Sigma certification. Bilingual (English / Spanish). Experience in Transplant knowledge. Physical Demands: Regularly required to talk or hear. Frequently lifts and/or moves up to 10 pounds. Benefits: Competitive compensation package. Equal Opportunity/Affirmative Action Employer.

Back to blog

Yelp Question and Answer

$150 $49

Amzon Question and Answer

$150 $49

Netflix Question and Answer

$150 $49

Disney Question and Answer

$150 $49

Apple Question and Answer

$150 $49

Southwest Airline Q & A

$150 $49

Delta Airline Q & A

$150 $49

Costco Question and Answer

$150 $49

American Question and Answer

$150 $49

Walmart Question and Answer

$150 $49

Tesla Question and Answer

$150 $49

Google Question and Answer

$150 $49

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...