Sr Review Coordinator

Integrated Management Strategies, LLC; United States; Remote; USD 65,000 - 90,000; Full time

Job summary

Integrated Management Strategies, LLC is seeking an experienced Sr Review Coordinator for our healthcare consulting practice. This fully remote role within the United States focuses on utilization review of plans of service for home and community-based programs, supporting non-clinical reviewers, and ensuring timely, quality decisions to improve access to care.

The candidate will review complex plans of service, document decisions, and liaise with providers while maintaining strong communication

Qualifications

• Active Maryland RN License or Social Worker License.
• 3–5 years of recent clinical experience.
• Ability to maintain regular and predictable attendance.
• Good written and oral communication skills.
• Up to 5% local travel.

Responsibilities

• Perform utilization review of plans of service for home and community-based programs.
• Review complex plans of service and act as a resource for non-clinical reviewers.
• Provide independent review decisions for behavioral health services and the appropriateness of quality of care based on contract, state and URAC requirements.
• Screen situations according to criteria to determine if care is appropriate.
• Ensure reviews are conducted thoroughly within specified timeframes.
• Serve as liaison among providers, facilities, and subscribers.
• Document medical information supporting decisions in the workflow system clearly and timely.

Skills

Strong communication

Attention to detail

Time management

Remote work readiness

Education

RN License

Social Worker License

Tools

EHR software

Job description

About the role

Are you ready for your next career adventure?! Integrated Management Strategies (IMS) is an award-winning, fast-growing woman-owned small business in the Washington DC area, specializing in healthcare, technology, and management consulting. We are seeking an experienced Sr Review Coordinator to join our healthcare consulting practice. The role is fully remote within the US. We are proud of our national presence, and excited to offer great career opportunities within the organization.

As a Senior Review Coordinator, you will be responsible for performing utilization review of plans of service for home and community-based programs. You will review the complex plans of service and act as a resource for non-clinical reviewers. This position directly impacts the MD population and their access to much-needed services. This position makes a difference in people's lives by ensuring they receive adequate support to remain at home instead of an institution.

Training for this role will take place remotely. Training is expected to run for approximately 4-6 weeks during standard business hours. Training duration is dependent upon the individual and may run longer or shorter depending on needs.

What you'll do

• Perform utilization review of plans of service for home and community-based programs
• You will review the complex plans of service and act as a resource for non-clinical reviewers
• You will provide independent review decisions for behavioral health services and the appropriateness of quality of care based on contract, state and/or URAC requirements
• You will screen situations according to specific criteria to determine if care is appropriate
• Ensure review is conducted thoroughly and within specified timeframes
• Serve as liaison among providers, facilities, and/or subscribers
• Document medical information supporting decisions into the workflow documentation system, ensuring data is entered accurately and timely

Required Qualifications

• Active Maryland RN License (OR) Social Worker License
• 3 - 5 years of recent experience working in a clinical environment
• Because of the nature and immediacy of the work, the ability to maintain regular and predictable attendance is essential
• Good written and oral communication skills
• Up to 5% local travel

Preferred Qualifications

• Prior UM experience
• Knowledge of medical coding and billing
• Durable Medical Equipment experience
• Discharge planning experience
• Typing and data entry skills, familiarity with computer systems, and use of multiple monitor work systems

Integrated Management Strategies is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, gender identity, national origin, disability, pregnancy, status as a protected veteran, or any other protected characteristic as outlined by federal, state, or local laws. If you are an individual with a disability and would like to request a reasonable accommodation for the employment process, please email your request to [e-mail]

E-Verify® is a registered trademark of the U.S. Department of Homeland Security. This business uses E-Verify in its hiring practices to achieve a lawful workforce. www.dhs.gov/E-Verify

The salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary rate for this position will be determined by a number of factors, including, scope, complexity, and location of the role; the skills, education, training, credentials, and experience of the candidate, and other conditions of employment.