Clinical Review Coordinator - Remote

Overview

The Clinical Review Coordinator conducts mandatory case review and quality assurance activities, ensuring timeliness and accuracy in the review process.

In Short

• Conducts case reviews and quality assurance activities.
• Maintains an efficient case review process.
• Interprets coverage and payment policies.
• Communicates with physician reviewers.
• Informs Medicare beneficiaries and healthcare providers.
• Edits documentation for dissemination.
• Protects patient confidentiality per HIPAA regulations.
• Performs desktop medical reviews.
• Acts as a liaison for beneficiaries.
• Develops relationships with community agencies.

Requirements

• Graduation from an accredited nursing school and current RN or LPN licensure.
• Experience with Medicare QIO and clinical decision-making.
• Quality of care review experience.
• Detail-oriented with knowledge of medical terminology.
• Strong organizational and communication skills.
• Ability to work independently.
• Problem-solving skills.
• Minimum of two to four years of relevant experience.
• Must reside in the Las Vegas, NV area.
• Compliance with licensing and certification requirements.

Benefits

• Opportunity to work with a purpose-driven organization.
• Engagement in meaningful healthcare projects.
• Flexible work arrangements.
• Professional development opportunities.
• Supportive team environment.
• Competitive salary and benefits.
• Access to healthcare-related resources.
• Collaboration with healthcare professionals.
• Commitment to equal employment opportunities.
• Potential for career advancement.