Job Description

Job Description

Job Description

On behalf of our client, we are looking for a Case Reviewer to join our team of professionals. If the description below sounds like you, Apply Now!

*Candidates must live within driving distance of Columbia, MD and have a background in administrative healthcare*

As a Case Reviewer , you will be responsible for inbound and outbound communication in support of case review activities including collection and confirmation of data integrity in support of clinical review services.

In this role, you will:

• Interpret review guidelines to facilitate forward movement of the case review process including requests for clinical information, treatment plans, discharge dates, and communicating the authorization for requested services.
• Coordinate, distribute, and track highly confidential medical information from multiple sources (fax, web, and phone).
• Interpret and adhere to URAC standards for assigned programs as well as federal and state requirements.
• Ensure quality customer service by responding to phone inquiries from members, physicians, and providers.
• Prioritize workload to meet program or regulatory time frames.
• Provide verbal and written communications of review decisions to include administrative denials.
• Complete service/treatment screens for accurate transmission of outcome decisions.
• Provide general office support and perform miscellaneous duties as assigned.

In this role, you'll need:

• High school diploma or equivalent.
• 2 years of experience working in a customer service or healthcare environment.
• Demonstrated ability working with confidential information and in a deadline-driven environment.
• Excellent verbal and written communication skills and intermediate PC skills.
• Positions working on specific contracts may require U.S. Citizenship.
• Satisfactory completion of medical terminology course preferred.
• Experience in a health care environment preferred.
• Satisfactory completion of medical terminology course preferred.
• Intermediate PC functions preferred.

We are unable to consider candidates outside of the United States, candidates in the state of California, or those in US Minor outlying islands and territories.

Shift :

Monday-Friday from 8am-5pm Eastern

Candidates should be within driving distance of the office in Columbia, Maryland. After the training period, candidates will work remote with some potential to in office travel. All equipment will be provided.

Base Pay :

$21.00 / hour

Why work for our client?

Our client is one of the country's most respected population health management organizations. They work with state and federal government programs, as well as employers and health plans offering clinical, analytical, and technical expertise.

Health has changed a lot through our 50-year history, but what has remained constant is that they care deeply about who they serve and what they do. Their success is built on their ability to adapt, respond to client needs, and offer innovative solutions at every turn.

Our client is looking for talented individuals who not only believe in the mission but who are ready to take ownership and make a difference in the lives of people, in the world of health.

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