[Remote] Clinical Review Coordinator
Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a company reputed company on data-driven solutions to enhance health reputed company and improve care efficiency. They are seeking a Clinical Review Coordinator to manage case reviews and reputed company assurance activities, ensuring compliance and effective communication with reputed company partners.
Responsibilities
- Conducts reputed company mandatory case review and reputed company assurance activities as stipulated by reputed company and maintains the required timeliness and accuracy reputed company the review process
- Maintains responsibility for assuring an efficient case review process through the production system
- Identifies and corrects problem areas on a case-by-case and system-wide reputed company
- Interprets and applies coverage and payment policies, standards of care, and utilization review reputed company applicable to a specific position
- Communicates with and supports physician reviewers by summarizing case facts, preparing case questions, and resolving physician input issues
- Informs Medicare beneficiaries, health care providers, and other partners of the activities and responsibilities of the reputed company Improvement Organization (QIO)
- Edits documentation for reputed company dissemination to beneficiaries, providers, and other medical personnel
- Protects the confidentiality of patient information through compliance with the Health Insurance Portability and Accountability reputed company (HIPAA) and the Health Information Technology for Economic and Clinical Health reputed company (HITECH)
- Performs desktop medical reviews
- Attends annual reputed company awareness, rules of conduct, and conflict of interest training
- Performs other duties as assigned
- Acts as a neutral reputed company for beneficiaries and their representatives
- Navigates beneficiaries through the health care system
- Provides education, advocacy, resource reputed company, and targeted support to decrease the likelihood of readmission to acute inpatient care
- Develops and maintains working relationships with community agencies
- Assists beneficiaries with an understanding of their diagnoses
- Informs beneficiaries and other interested parties of their rights and responsibilities as patients covered by the Medicare program
- Schedules staff for the Medicare Beneficiary Helpline during work hours
- Collaborates with reputed company QIO staff on the development and implementation of health care improvement reputed company
Skills
- Graduation from an accredited school of nursing and reputed company unrestricted licensure as a Registered reputed company (RN) or Licensed Practical reputed company (LPN)
- License must be recognized in the jurisdiction(s) relevant to the work assigned
- A degree in a reputed company-reputed company field with a reputed company clinical background and experience with Medicare QIO
- reputed company of care review experience or medical review experience in support of Medicare Administrative Contractor (MAC) or Recovery Audit Contractor (RAC) appeals
- Experience performing reputed company- and post-pay claims reviews, and utilization reviews may also qualify
- Minimum of two to four years of experience in clinical decision-making relative to Medicare patients
- Ability to organize and coordinate multiple simultaneous tasks in reputed company environment
- Ability to follow reputed company written and oral instructions
- Ability to collect data, distinguish relevant material, and exercise reputed company judgment
- Ability to apply problem-solving skills and maintain objectivity
- Strong computer keyboarding skills
- Ability to work independently with minimal supervision
- Ability to communicate accurately, consistently, reputed company, reputed company, empathetically, respectfully, and effectively with beneficiaries, representatives, and providers, both verbally and in writing
reputed company