Senior Review Coordinator

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

📋 Description

• Conduct utilization reviews of service plans for home and community-based programs.

• Review intricate service plans and serve as a resource for non-clinical reviewers.

• Provide independent review decisions regarding behavioral health services and evaluate the quality of care appropriateness.

• Analyze situations based on specific criteria to ascertain the appropriateness of care.

• Ensure that reviews are performed comprehensively and adhere to specified timelines.

• Act as a liaison between providers, facilities, and/or subscribers.

• Document medical information that supports decisions in the workflow documentation system.

• Input data accurately and in a timely manner.

• Engage in approximately 4–6 weeks of remote training during standard business hours.

⛳️ Requirements

• Active RN License in Maryland (OR) Social Worker License.

• 3–5 years of recent experience in a clinical setting.

• Ability to maintain consistent and predictable attendance.

• Strong written and verbal communication skills.

• Up to 5% local travel may be required.

• Prior experience in Utilization Management is preferred.

• Familiarity with medical coding and billing is preferred.

• Experience with Durable Medical Equipment is preferred.

• Discharge planning experience is preferred.

• Proficiency in typing and data entry is preferred.

• Knowledge of computer systems and the use of multiple monitor work setups is preferred.

• Capability to perform tasks in accordance with contract, state, and/or URAC requirements.

• Compliance with E-Verify employment eligibility requirements.

🏝️ Benefits

• Fully remote work environment within the US.

• Remote training provided.

• An equal opportunity employer dedicated to diversity and inclusion.

• Reasonable accommodations available throughout the employment process.