Clinical Review & Certification Coordinator

MedWatch, LLC; Florida; Remote; USD 32,000 - 37,000; Full time

Job summary

MedWatch, LLC is seeking a Medical Review Coordinator in Florida to review medical data, determine precertification decisions, and document findings in the clinical record. You will interact with the Utilization Review team and Physician Advisors to ensure timely decisions, pregnancy case data collection, and efficient discharge and closure processes.

Requirements include an Associate degree or equivalent, current LPN licensure, and 3 years of clinical nursing experience, with strong

Qualifications

• Associate’s degree or equivalent education and experience.
• Licensed Practical Nurse (current unrestricted, in state of practice).
• 3 years clinical nursing experience.
• Excellent verbal and written communication skills.
• Good organizational skills and time management.
• Ability to handle difficult situations tactfully and diplomatically.
• Effective problem solving and decision-making skills.
• Strong computer skills with MS Office Suite products (Word, Excel, PowerPoint).

Responsibilities

• Review medical data obtained by mail or fax and enter into the clinical record for review by the utilization review specialist.
• Review and determine certification decision for all precertification cases forwarded to her by the utilization review specialist.
• Document all information obtained according to MedWatch policy.
• Follow-up post procedure to obtain the pathology report as appropriate and send a notification memo to the claims office advising of the results and any additional treatment needed.
• Discuss all cases lacking clinical information to allow certification with her supervisor prior to sending to the appropriate Physician Advisor for review.
• Follow up to assure PA response timely within MedWatch guidelines.
• Obtain clinical information on all pregnancy cases as directed by MedWatch protocol.
• Discuss any case with the Medical Review Specialist which may include high risk OB clinical and memo the claims office information obtained.
• Forward the case to the assigned utilization review specialist for follow-up at the time of delivery.
• At the direction of the Medical Review Specialist, discuss potential case management referrals with the case management supervisor and refer as directed to the claims office.
• Obtain discharge dates and bill totals for the Medical Review Specialist at the time of discharge to expedite closure of cases.
• Adhere to all company policies as stated in the employee handbook.
• Assist with projects as directed by the Director of Utilization Review.
• Participate in the Quality Management Program by adhering to all company policies and procedures and identifying opportunities for improvement to ensure quality services are rendered to clients and customers.
• The incumbent may be responsible for duties or responsibilities that are not listed in this job description. Duties and responsibilities may change at any time with or without notice.
• The salary range for this position is from $23 to $27 per hour.

Skills

Organizational skills

Time management

Verbal communication

Written communication

Problem solving

Decision making

MS Office proficiency

Education

Associate degree or equivalent

Licensed Practical Nurse (LPN)

Tools

MS Office Suite

Job description

MedWatch, LLC is seeking a Medical Review Coordinator in Florida to review medical data, determine precertification decisions, and document findings in the clinical record. You will interact with the Utilization Review team and Physician Advisors to ensure timely decisions, pregnancy case data collection, and efficient discharge and closure processes.

Requirements include an Associate degree or equivalent, current LPN licensure, and 3 years of clinical nursing experience, with strong