Medical Review Coordinator — Home Office Role

MedWatch; Stati Uniti; Remoto; USD 32.000 - 37.000; Tempo pieno

Descrizione del lavoro

MedWatch in the United States is seeking a Medical Review Coordinator. The role requires a current LPN license and at least 3 years of clinical nursing experience, with strong organizational and communication skills.

You will review medical data, determine precertification decisions, and collaborate with physicians and claims staff to ensure timely, accurate certification. This position emphasizes adherence to MedWatch procedures and URAC standards, with opportunities to participate in quality

Competenze

• Licensed Practical Nurse (current unrestricted, in state of practice).
• 3 years clinical nursing experience.
• Strong organizational, communication and problem-solving abilities.

Mansioni

• Review medical data and enter into the clinical record for review by UR specialist.
• Determine certification decisions for precertification cases and document per policy.
• Discuss cases with supervisor and route to Physician Advisor for review.
• Obtain clinical information on all pregnancy cases as directed.
• Discuss cases with Medical Review Specialist and refer as directed to case management.
• Refer potential case management referrals to the case management supervisor.
• Obtain discharge dates and bill totals to expedite case closure.
• Adhere to all company policies and participate in Quality Management.
• Duties may change and include additional responsibilities.

Conoscenze

Organizational skills

Verbal and written communication

Tactful/diplomatic in difficult Situ

Problem solving & decision making

MS Office proficiency

Formazione

Associate’s degree or equivalent education and experience

Strumenti

MS Office Suite

Descrizione del lavoro

MedWatch in the United States is seeking a Medical Review Coordinator. The role requires a current LPN license and at least 3 years of clinical nursing experience, with strong organizational and communication skills.

You will review medical data, determine precertification decisions, and collaborate with physicians and claims staff to ensure timely, accurate certification. This position emphasizes adherence to MedWatch procedures and URAC standards, with opportunities to participate in quality