Remote Clinical Review Specialist — Utilization Management

New England Life Care, Inc.; Portland (ME); Remote; USD 55,000 - 75,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Generous 403(b) savings program

Company paid life insurance

Short- and long-term disability

Paid Time Off

Job summary

New England Life Care (NELC) is a leading non‑profit home infusion provider serving Maine, New Hampshire and Massachusetts. This remote Clinical Review Specialist role supports utilization management, reviews therapy checklists, and communicates coverage decisions to patients and providers.

You will work with the Medical Director to address denials and ensure compliance with state and federal requirements. The position offers a Monday–Friday schedule with standard daytime hours, inclusive

Qualifications

• Must have Medical Assistant certification or MA/LPN credentials.
• Experience in care coordination, home health or home infusion is required.
• Familiarity with HIPAA Privacy and Security Regulations is required.

Responsibilities

• Apply clinical criteria, eligibility and benefit information to ensure high‑quality, cost‑effective care.
• Review clinical documentation for long‑term government payers twice yearly for ongoing coverage.
• Consult with Medical Director for potential denials not meeting medical necessity.
• Communicate coverage decisions clearly to members, providers, and medical groups.

Skills

Dependability

Communication (verbal & written)

Problem solving

Organization & prioritization

Independent work

Computer skills (MS Word, Outlook, Web

Education

Medical Assistant certification

MA or LPN license

Associate degree or higher (preferred)

Tools

Microsoft Word

Outlook

Internet

Job description

New England Life Care (NELC) is a leading non‑profit home infusion provider serving Maine, New Hampshire and Massachusetts. This remote Clinical Review Specialist role supports utilization management, reviews therapy checklists, and communicates coverage decisions to patients and providers.

You will work with the Medical Director to address denials and ensure compliance with state and federal requirements. The position offers a Monday–Friday schedule with standard daytime hours, inclusive