Clinical Review Coordinator — MedWatch & Utilization Specialist

MedWatch; Florida; Hybrid; USD 32,000 - 37,000; Full time

Job summary

MedWatch is seeking a Medical Review Coordinator in Florida to perform clinical review duties in line with URAC standards and state requirements. The role requires an LPN license, an Associate’s degree or equivalent, and at least three years of clinical nursing experience.

You will review medical data, determine precertification decisions, document findings, and coordinate with the Medical Review Specialist and Physician Advisor to ensure accurate and timely certifications.

Qualifications

• Associate’s degree or equivalent education and experience.
• Licensed Practical Nurse (current unrestricted, in state of practice).
• 3 years clinical nursing experience.
• Strong organizational and time-management abilities.
• Excellent verbal and written communication skills.
• Ability to handle difficult situations tactfully and diplomatically.
• Problem solving and decision-making skills.
• Proficient in MS Office (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 and follow up on pathology reports as needed.
• Discuss cases lacking clinical information with supervisor before sending to Physician Advisor for review.
• Obtain discharge dates and bill totals to expedite case closure.
• Adhere to company policies and participate in the Quality Management Program.
• Assist with projects as directed by the Director of Utilization Review.

Skills

Organizational skills

Time management

Verbal communication

Written communication

Diplomacy

Problem solving

MS Office proficiency

Education

Associate’s degree or equivalent

Licensed Practical Nurse (LPN)

Tools

MS Office Suite

Job description

MedWatch is seeking a Medical Review Coordinator in Florida to perform clinical review duties in line with URAC standards and state requirements. The role requires an LPN license, an Associate’s degree or equivalent, and at least three years of clinical nursing experience.

You will review medical data, determine precertification decisions, document findings, and coordinate with the Medical Review Specialist and Physician Advisor to ensure accurate and timely certifications.