Case Reviewer

This is a fully remote position, open to applicants in Maryland.

📋 Description

• Perform comprehensive evaluations of prior authorization requests to assess medical necessity and adherence to established guidelines and criteria.

• Evaluate and oversee the suitability of healthcare services, ensuring they align with evidence-based practices and organizational policies.

• Work collaboratively with participant supports and internal teams to enhance communication and resolve authorization requests.

• Keep precise and detailed records of reviews and decisions in accordance with regulatory requirements and organizational standards.

• Remain updated on changes in medical guidelines, policies, and regulations.

• Engage in quality improvement initiatives.

⛳️ Requirements

• Bachelor's degree in a relevant field.

• Dedication to keeping up with developments in medical guidelines, policies, and regulations.

• Openness to participating in ongoing education and training opportunities.

• Experience or interest in engaging in quality improvement initiatives.

• Ability to interact effectively with a diverse patient population and colleagues.

• Strong organizational skills and capacity to manage multiple tasks and priorities.

• Prior knowledge of Utilization Management is preferred.

• Familiarity with Home and Community Based Services (HCBS) waiver programs is advantageous.

• Knowledge of Durable Medical Equipment (DME) is a plus.

• Excellent written and verbal communication skills are required.

• Proficient typing and data entry skills.

• Familiarity with computer systems and multiple-monitor work setups.

• Must reside in Maryland.

• Quarterly travel to Columbia, MD for training is required.

• E-Verify will be utilized in hiring practices to ensure a lawful workforce.

🏝️ Benefits

• Fully remote work option within the US.

• Quarterly travel to Columbia, MD for training.

• Continuous education and training opportunities.

• Commitment to equal opportunity and diversity and inclusion.

• Reasonable accommodations available for individuals with disabilities.