Clinical Review Coordinator (Healthcare)

TL;DR

Clinical Review Coordinator (Healthcare): Conducting mandatory case reviews and quality assurance activities to ensure compliance with Medicare standards and healthcare policies. Focus on interpreting coverage criteria, supporting physician reviewers, and maintaining high standards of documentation accuracy and patient data confidentiality.

Location: Must reside in the Las Vegas, NV area

Salary: $83,200

Company

hirify.global is a data-centric healthcare company focused on transforming health outcomes through quality data-driven solutions and clinical expertise.

What you will do

• Conduct mandatory case reviews and quality assurance activities as stipulated by contracts.
• Interpret and apply coverage and payment policies, standards of care, and utilization review criteria.
• Summarize case facts and support physician reviewers in resolving input issues.
• Protect patient information in compliance with HIPAA and HITECH regulations.
• Perform desktop medical reviews and identify problem areas on a case-by-case basis.
• Educate beneficiaries and providers on QIO activities and patient rights.

Requirements

• Must reside in the Las Vegas, NV area
• Graduation from an accredited school of nursing with current unrestricted RN or LPN licensure.
• Degree in a healthcare-related field with professional clinical background.
• Minimum of 2-4 years of experience in clinical decision-making relative to Medicare patients.
• Experience with Medicare QIO, MAC, or RAC appeals and utilization reviews.
• Strong computer keyboarding skills and ability to work independently.

Culture & Benefits

• Purpose-driven culture with a focus on straightforward communication.
• Opportunity to work in a mission-critical role within the healthcare sector.
• Professional environment with a focus on clinical domain expertise.
• Standard full-time employment benefits and support.