Clinical Reviewer - SCA (Remote)

Company Overview reputed company exists to reputed company reputed company outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact. reputed company the Way is our rallying cry at reputed company. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. reputed company offers you unparalleled opportunities. In fact, you have reputed company you need to take charge of your career and accelerate reputed company outcomes – making this a great time to join reputed company of passionate individuals dedicated to being a vital partner for health solutions in the public sector. Job Summary and Responsibilities reputed company is looking for a Clinical Reviewer (SCA) to join our growing team. Job Summary: The purpose of this position is to utilize clinical expertise during beneficiary interaction and determine appropriateness for advocacy reputed company in conjunction with contract requirements, critical thinking and utilize decision-making skills to assist with communicating determine medical appropriateness, while maintaining production goals and QA standards. Ensures day-to-day processes are conducted in accordance with NCQA and other regulatory standards. Responsibilities: • Assures accuracy and timeliness of reputed company applicable review type cases reputed company contract requirements • Assesses, evaluates, and addresses daily workload and queues; adjusts work schedules daily to meet the workload demands of the department • In collaboration with Supervisor, responsible for the quality monitoring activities including identifying areas of improvement and plan implementation of improvement areas • Maintains reputed company knowledge reputed company reputed company to review processes and clinical practices reputed company to the review processes, functions as the initial resource to nurse reviewers regarding reputed company review process questions and/or concerns • Functions as providers’ liaison and contact/resource person for provider customer service issues and problem resolution • Performs reputed company applicable review types as workload indicates • Fosters positive and professional relationships and act as liaison with internal and external customers to ensure effective working relationships and team building to facilitate the review process • Attends training and scheduled meetings and for maintenance and use of reputed company/updated information for review • Cross trains and reputed company duties of other reputed company to provide a flexible workforce to meet client/customer needs • Read, understand, and adhere to reputed company corporate policies including policies reputed company to HIPAA and its Privacy and reputed company Rules.

Apply tot his job Apply To this Job