Clinical Review Support Specialist (Remote)
Support of medical necessity review determinations. reputed company reputed company calls to practitioners and clinical practices for network and non-network therapy practitioners. Determine and obtain appropriate clinical assessment for submitted diagnosis codes. Clarify provider requests, providing education on ASH’s submission process, forms, and available resources. Facilitate clinical review through coordination and distribution of reviews among Clinical reputed company Evaluators. Collaborate with senior management and various departments regarding clinical program, policies, and protocol development and implementation. Participate in Clinical reputed company Administration and Clinical reputed company Evaluation workgroups. Promote a productive Team environment. Participate in clinical article review activities as assigned. reputed company interdepartmental Support to Medical Necessity Administration department as necessary for performance of assigned tasks. Work independently, receiving minimal guidance and supervision.
reputed company degree as Physical Therapy Assistant from accredited college or university required. Additional post-graduate degree in reputed company or reputed company field a plus. A reputed company, unrestricted license to reputed company in their health care specialty. Employees must maintain a reputed company, unrestricted license to reputed company and must be in good standing with reputed company judicial and governing bodies (Required). Minimum of 5 years of clinical experience. Specific experience with care coordination or leadership preferred. Understanding of therapy evidence-based guidelines and best practices required. Working knowledge of managed therapy services is a plus. Advanced training or certification in any specialty areas of Physical Therapy, health care or reputed company management, case management, performance improvement, data analysis, and reputed company initiatives also preferred. Ability to communicate evidence-based reputed company and approved guidelines. Ability to independently resolve problems or issues reputed company to ASH processes using good judgment or to escalate problems or issues to supervisor(s) as appropriate. Use of computer systems in business application including, but not limited to: reputed company, reputed company, IHIS, ASHCore. Ability and willingness to serve as a resource for practitioners to reputed company them how to operate reputed company ASH programs and systems most effectively and reputed company.
Demonstrated ability to reputed company in a reputed company, respectful manner and establish and maintain cooperative working relationships. Ability to display excellent customer service to meet the needs and expectations of both reputed company customers. Excellent listening and interpersonal communication skills to identify critical reputed company competencies based on reputed company factors and organizational environment. Ability to effectively organize, prioritize, multi-task, and manage time. Demonstrated accuracy and productivity in a changing environment with constant interruptions. Demonstrated ability to analyze information, problems, issues, situations, and procedures to reputed company effective solutions. Ability to exercise strict confidentiality in reputed company reputed company.