Clinical Review Coordinator (Healthcare)

TL;DR

Clinical Review Coordinator (Healthcare): Conducting mandatory case reviews and quality assurance activities with an accent on regulatory compliance and clinical accuracy. Focus on interpreting payment policies, coordinating with physician reviewers, and ensuring HIPAA compliance.

Location: Must reside in the Las Vegas, NV area (Remote)

Salary: $60,000 - $83,200

Company

A data-centric healthcare transformation company focusing on improving health outcomes through clinical expertise and technology.

What you will do

• Conduct mandatory case reviews and quality assurance activities to maintain timeliness and accuracy.
• Interpret and apply coverage and payment policies, standards of care, and utilization review criteria.
• Support physician reviewers by summarizing case facts, preparing questions, and resolving input issues.
• Communicate with Medicare beneficiaries and providers regarding Quality Improvement Organization (QIO) activities.
• Ensure strict confidentiality of patient information in compliance with HIPAA and HITECH.
• Act as a liaison for beneficiaries, providing education, advocacy, and resource access to reduce readmissions.

Requirements

• Current unrestricted licensure as a Registered Nurse (RN) or Licensed Practical Nurse (LPN).
• Degree in a healthcare-related field with a 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, including pre- and post-pay claims reviews.
• Must reside in the Las Vegas, NV area.
• Detailed orientation and clinical knowledge of medical terminology.

Culture & Benefits

• Fully remote work environment.
• Purpose-driven culture with a focus on human-centered, value-based solutions.
• Commitment to equal employment opportunity and merit-based processes.
• Straightforward communication and professional growth in a data-centric healthcare setting.