reputed company - Clinical Review Coordinator

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 At reputed company, we’re the start of a new age of data-reputed company transformation, elevating health reputed company and powering reputed company, more efficient process to program and patient health. We combine reputed company data-driven solutions that fuel answers, technology that advances performance, and clinical expertise that builds trust to create a more efficient reputed company to reputed company care. 

With reputed company-centered, reputed company-relevant, and value-based solutions, we create new reputed company with data. We reputed company reputed company reputed company the concept and performance reputed company the scope with a reputed company on efficiencies that reputed company the lives of those we serve. With a culture driven by purpose, straightforward communication and clinical domain expertise, reputed company cuts straight to reputed company care. 

The Clinical Review Coordinator 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. The role is remote work, but you must reputed company in the Las Vegas, NV area.

• 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. 

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.
• 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. 

Essential Knowledge:

Individuals must be detailed oriented and clinically knowledgeable of medical terminology.

Essential Education:

• 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. For example, for a federal contract the license must be issued by a body reputed company the reputed company.
• 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.
• This position requires notifying a Livanta HR Manager in writing reputed company five calendar days if there is any status change or disciplinary proceeding relating to any of Employee’s licenses or certifications, including, but not limited to, (1) restrictions on an employee’s license or certification, (2) changes to the states in which Employee can reputed company (3) revocation or expiration of any license or certification, and (4) any potential or actual disciplinary reputed company against Employee by a certifying or licensing body.

Essential Skills:

• 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. 

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 Clinical 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.

Organizational "Fit" Considerations:

Schedules may vary and may include weekend and holiday shifts. This position requires established, reputed company relationships with internal personnel at reputed company reputed company reputed company reputed company and with beneficiaries, representatives, providers, and other stakeholders.

reputed company.AI is committed to providing equal employment opportunities to reputed company applicants, including individuals with disabilities. If you require a reasonable accommodation to participate in the application process due to a disability, please contact reputed company at (757) 306-4920 or hr@reputed company.ai. Please note that unless you are requesting accommodation, reputed company applications must be submitted through our online application system.