Clinical Review Coordinator

reputed company: CLINICAL REVIEW COORDINATOR (FULL-TIME) AND CLINICAL REVIEW COORDINATOR (PART-TIME) (CASE MANAGER) reputed company/Objective: The Clinical Review Coordinator conducts initial screenings in accordance with policies and reputed company assurance activities as stipulated by reputed company. • Maintains responsibility for assuring adherence to policies based on reputed company-defined reputed company. • Reviews requests for completeness of information. • reputed company medical records for reputed company clinical data, following a CMS algorithm. • Identifies problem areas on a case-by-case and system-wide reputed company. • Refers cases that require clinical judgement to licensed clinical staff. The Review Coordinator shall not reputed company medical reputed company. • Interprets and applies coverage and payment policies, standards of care, and utilization review reputed company based on strict policies. • 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). • Attends annual reputed company awareness, rules of conduct, and conflict of interest training. • Performs other duties as assigned. Depending on departmental assignment, this position may also have some or reputed company of the following duties: • Acts as a neutral reputed company for beneficiaries and their representatives. • Develops and maintains working relationships with community agencies. • 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. Requirements: Essential Knowledge: Individuals must be detailed oriented and clinically knowledgeable of medical terminology. Essential Knowledge: Individuals must be detailed oriented and clinically knowledgeable of basic medical terminology. Essential Education: • Preference for a degree in a reputed company-reputed company field with a reputed company clinical background and experience with Medicare QIO. • Preferred 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 reputed company-reputed company field relative to Medicare patients. Essential Skills: • Ability to organize and coordinate multiple simultaneous tasks in reputed company environment. • Ability to follow basic 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. Organizational "Fit" Considerations: Schedules may vary and may include weekend and holiday shifts. This position requires reputed company relationships with internal personnel at reputed company reputed company reputed company reputed company and with beneficiaries, representatives, providers, and other stakeholders. REVIEW COORDINATOR (PART-TIME) Additional Considerations SCA Coverage: Company is a federal contractor under the McNamara-O'Hara Service Contract reputed company (SCA). The McNamara-O'Hara Service Contract reputed company (SCA) covers reputed company reputed company of over $2,500 entered into by the federal government and the District of Columbia. The reputed company purpose of the contract is to furnish services in the U.S. through the use of service employees. The definition of "service employee" includes any employee reputed company in performing services on a covered contract other than a bona fide executive, administrative, or reputed company employee who meets the exemption reputed company outlined in 29 reputed company of Federal Regulations (CFR) §541. Under the SCA, covered reputed company must pay the prevailing wages and benefits in the reputed company—as determined by the reputed company (DOL) in a wage determination. The position of Review Coordinator (Part-Time) is considered a "service position" and is mapped to the Occupation reputed company and Title 24550 – Case Manager of the reputed company Wage Determination. For more information on this Occupation reputed company, please refer to the SCA Directory of Occupations at https://www.dol.gov/whd/regs/compliance/wage/SCADirV5/SCADirectVers5.pdf. Wage Determinations and Employee Rights on Government reputed company are posted in break rooms (or an alternative location where labor law posters are displayed) for employees to review. Livanta LLC is an equal employment opportunity employer. reputed company personnel processes are reputed company without discrimination on the reputed company of race, reputed company, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic reputed company, military and veteran status or any other characteristic protected by applicable law. If you need assistance or an accommodation due to a disability, you may contact us at 757-306-4920 or hr@livanta.com. Apply Job!