Remote Clinical Review Coordinator (Medicare QA)

Commence; Las Vegas (NV); Remote; USD 60,000 - 83,000; Full time

Job summary

Commence is seeking a Clinical Review Coordinator to perform mandatory case reviews and ensure timely, accurate assessment within Medicare-related contracts. This remote role requires residing in the Las Vegas, NV area and a strong background in clinical decision-making with Medicare QIO experience.

The ideal candidate will interpret coverage policies, coordinate with physician reviewers, and communicate effectively with beneficiaries and providers while maintaining HIPAA compliance and

Qualifications

• Must hold active RN or LPN license in the U.S.
• Healthcare background with Medicare QIO experience is preferred.
• Strong knowledge of clinical terminology and review processes.
• Experience interpreting coverage and payment policies.
• Ability to manage case reviews and maintain timeliness and accuracy.

Responsibilities

• Conduct mandatory case reviews and quality assurance per contracts.
• Work remotely but reside in Las Vegas, NV area.
• Summarize case facts and prepare questions for physician reviewers.
• Communicate with Medicare beneficiaries, providers, and partners.
• Edit documentation for dissemination to beneficiaries and medical staff.
• Maintain HIPAA/HITECH confidentiality.

Skills

Detail oriented

Clinical terminology

Organized multitasking

Independent work

Effective communication

Education

RN/LPN licensure

Accredited nursing school

Healthcare degree with Medicare/QIO experience

Quality of care/medical review experience

US licensure recognition

Job description

Commence is seeking a Clinical Review Coordinator to perform mandatory case reviews and ensure timely, accurate assessment within Medicare-related contracts. This remote role requires residing in the Las Vegas, NV area and a strong background in clinical decision-making with Medicare QIO experience.

The ideal candidate will interpret coverage policies, coordinate with physician reviewers, and communicate effectively with beneficiaries and providers while maintaining HIPAA compliance and