Remote Clinical Utilization Review Specialist

New England Life Care, Inc.; Manchester (NH); Remote; USD 65,000 - 90,000; Full time

Benefits offered by this job

Health insurance

Generous 403(b) savings plan

Company-paid life insurance

Short- and long-term disability

Paid Time Off

Job summary

New England Life Care, Inc. is seeking a Remote Clinical Review Specialist to support utilization management and coverage determinations. This role operates Mon-Fri, 8:30am–5:00pm, and requires strong communication and analytical skills in a fast-paced environment.

The ideal candidate will have Medical Assistant certification, healthcare experience, and familiarity with payer contracts. Remote work is limited to residents of Maine, Massachusetts, and New Hampshire.

Qualifications

• Medical Assistant certification is required.
• Associate degree or higher is preferred.
• MA or LPN is preferred.

Responsibilities

• Conduct utilization management reviews and provide clinical information to confirm patient coverage.
• Maintain understanding of regulations, payer contracts, products, and NELC policies.
• Serve as subject matter expert on complex specialty drugs' clinical requirements.
• Review documentation for government payers to ensure continued medical necessity and compliance.
• Communicate coverage decisions to members, providers, and medical groups within required timelines.

Skills

Dependability

Verbal and written communication

Problem identification

Prioritization

Independent work

Computer skills

Education

Medical Assistant certification

Associate degree or higher preferred

MA or LPN preferred

Job description

New England Life Care, Inc. is seeking a Remote Clinical Review Specialist to support utilization management and coverage determinations. This role operates Mon-Fri, 8:30am–5:00pm, and requires strong communication and analytical skills in a fast-paced environment.

The ideal candidate will have Medical Assistant certification, healthcare experience, and familiarity with payer contracts. Remote work is limited to residents of Maine, Massachusetts, and New Hampshire.