Clinical Review Coordinator - Remote

Overview

The Clinical Review Coordinator conducts all mandatory case review and quality assurance activities as stipulated by contracts and maintains the required timeliness and accuracy within the review process.

In Short

• Conducts mandatory case review and quality assurance activities.
• Maintains efficiency in the case review process.
• Interprets coverage and payment policies.
• Communicates with physician reviewers and resolves input issues.
• Informs stakeholders about Quality Improvement Organization activities.
• Edits documentation for internal and external use.
• Ensures compliance with HIPAA and HITECH.
• Performs desktop medical reviews.
• Acts as a liaison for beneficiaries.
• Collaborates on health care improvement projects.

Requirements

• Graduation from an accredited nursing school.
• Current unrestricted RN or LPN licensure.
• Experience with Medicare QIO.
• Minimum of two to four years of clinical decision-making experience.
• Knowledge of medical terminology.
• Ability to organize and coordinate tasks in a team environment.
• Strong communication skills.
• Ability to work independently with minimal supervision.
• Problem-solving skills and sound judgment.
• Ability to follow complex instructions.

Benefits

• Equal employment opportunities.
• Support for individuals with disabilities.
• Flexible scheduling may include weekends and holidays.
• Professional development opportunities.
• Collaboration with healthcare professionals.