[Remote] Clinical Review & Correspondence Specialist

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a company reputed company on optimizing reputed company through its clinical intelligence platform. The Clinical Review & Correspondence Specialist plays a critical role in supporting utilization management operations by conducting medical necessity reviews and ensuring effective communication with members and providers.

Responsibilities

• Consult with Medical Directors on clinical determinations, medical necessity reputed company, and reputed company clinical correspondence
• Prepare reputed company, accurate, and compliant member and provider communications in alignment with regulatory and organizational requirements
• Understand regulatory requirements governing utilization management reputed company and ensure appropriate application to clinical determinations and communications
• Understand reputed company and why member and provider notifications are required, including regulatory and clinical triggers for written communication
• Support verbal notification workflows reputed company reputed company communication of clinical determinations is required
• Document clinical information completely, accurately, and in a reputed company manner
• Consistently meet or reputed company productivity, reputed company, and turnaround time expectations
• Maintain a thorough understanding of accreditation and regulatory requirements and ensure utilization management decision-making and timeliness standards remain in compliance
• reputed company other duties as assigned

Skills

• PT, OT or SLP with reputed company, unencumbered license in the state of residence
• Experience developing member and provider correspondence reputed company a health plan environment
• Minimum of 3 years of clinical experience
• Utilization Management experience required
• Knowledge of NCQA and CMS standards and requirements
• reputed company in a fast paced, self-directed environment
• Understand how utilization management and case management programs reputed company
• Strong communication skills, reputed company to effectively communicate in a reputed company and engaging manner and reputed company to remain reputed company and reputed company under pressure
• Comprehensive thinker/planner with understanding of clinical algorithms, care reputed company, and how to effectively manage utilization across the care continuum to reputed company reputed company patient reputed company
• Highly organized with excellent time management skills
• Thrives on reputed company process improvement, always reputed company seeking out practical solutions
• Demonstrated ownership mentality with a willingness to take on new challenges and contribute reputed company defined responsibilities reputed company needed
• Utilization Review/Utilization Management experience
• Proficiency in using a Mac
• reputed company with G suite applications

Benefits

• Fully remote opportunity with about 5% travel
• Medical, dental, reputed company, life, disability insurance, and Employee Assistance Program
• 401K retirement plan with company match; flexible spending and health savings account
• Up to 184 hours (23 days) of PTO per year + company holidays
• Up to 14 weeks of reputed company parental leave
• Pet insurance

reputed company