Clinical Reviewer assessing medical product evaluations under MDR regulations. Collaborating with experts to ensure compliance and quality in assessments.
About the role
- Works with leadership, clinical staff, key internal departments, and external customers to ensure optimum clinical outcomes for members
- Organizes, reviews, and interprets members’ medical records and compares them against proprietary program guidelines, CMS and FDA approved policies, and evidenced-based clinical criteria as appropriate to determine eligibility for bill sharing and advocacy for additional programs and interventions; determines if the medical record documentation supports the eligibility of requested and/or billed services
- Completes medical review casework as assigned and meets SLAs
- Abstracts review-related data/information accurately and timely in appropriate IT systems.
- Provides accurate and timely submission of all administrative and review-related documents to appropriate parties
- Provides appropriate consultation and referral to intra- and interdepartmental resources to ensure members receive optimum services offered by organization
- Makes case presentations to medical leadership for assistance in making sharing determinations
- Manages assigned clinical caseload meeting SLAs
- Delivers accurate and clear verbal and written communication to internal and external customers while complying with organizational HIPAA requirements
- Maintains accurate and timely records of all communications and interventions
- Performs ongoing process improvement for efficiencies and effectiveness
- Performs administrative and clinical processes to ensure team and departmental goals are met
- Contributes to the exercise and expression of Christian Care Ministry’s Christian beliefs
- All other duties as assigned
Requirements
- Current unrestricted compact LPN/LVN license with sound knowledge of anatomy and physiology, medical terminology, and disease processes required
- Graduate from an accredited Diploma, Associates Degree, or Bachelor’s Degree Program required, healthcare-related degree preferred
- 2+ years of clinical experience and/or care coordination in an acute or med-surgical environment required, oncology experience strongly preferred
- 1+ years working with EMRs and medical record/abstraction of data required; experience in bill coding and medical record reviews strongly preferred
- Must be proficient in Microsoft Office and internet/web navigation and research required.
Benefits
- 100% paid Medical for employees/99% for family
- Generous employer Health Savings Account (HSA) contributions
- Employer-paid Life Insurance (3x salary) and Long-term Disability Insurance
- 6 weeks of paid parental leave (for both mom and dad)
- Dental - two plans to choose from
- Vision
- Short-term Disability
- Accident, Critical Illness, Hospital Indemnity
- 401(k) – up to 4% match on ROTH or Traditional contributions
- Generous paid-time off and 11 paid holidays
- Wellness plan including Financial, Occupational, Mental/Spiritual, and Physical health incentives up to $50/mo
- Employee Assistance Program including no cost, in-person mental health visits and employee discounts
- Monetary Anniversary Awards Program
- Monetary Birthday Awards
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