If you have excellent customer service skills.
Some time working in Healthcare.
Excellent computer skills and writing skills.
Long term contract position, comes with benefits.
Please send your resume to
sbenson@nri-staffing.com
Position Type
Full-Time/Regular
* Assist providers to submit documentation of requests for case management, utilization review, and other medical management services.
* Enter documentation of requests for case management, utilization review, and other medical management services (collect/enter information into the system that is limited to non-clinical data or is structured clinical data).
* Convey case information and other notifications via inbound and outbound calls.
* Validate the request submitted via Health Provider Portal for accuracy and completeness.
* Screen cases for required medical information based on type of request, determining if information is sufficient for clinical review
* Obtain clinical information from the client systems when indicated or contact provider to obtain information required for review.
* Process requests after physician review, evaluating language and working with physician reviewers, clinical reviewers, or managers to ensure language and determination information is complete before sending letters to providers
* Respond to inbound telephone requests with clear documentation in the care management system of calls.
* Enter case information from original source documentation or validate information entered by providers in the portal
* Make courtesy calls with case reference numbers.
* Provide notification of completed review and additional information needed, when applicable
* Contribute to orientation and training of other non-clinical employees
* As requested, create templates for complex reviews, perform internal quality reviews, and/or participate in provider outreach activities
* May perform scripted clinical reviews and refer reviews requiring further action to clinical review staff
* After physician review, notify providers of decertification or potential denial of services by phone or in writing as required by contract.
* Complete case after physician review, returning to clinician or sending to client based on procedure
Added accountabilities when performing case management support (as appropriate) include but are not limited to:
* Arrange ancillary authorization requests such as transportation, accommodation
* Obtain customer consent for care management services to be performed
* Correspond with facilities, providers, and others
* Coordinate non-clinical functions and intervention, as directed
* Supervised closure of cases upon completion of review by a clinical reviewer, as directed
Knowledge of the Medicaid eligibility system.
What would make you a strong fit for our role:
* Intermediate understanding of medical terminology
* Intermediate MS Office Suite proficiency
* Demonstrated proficiency with medical terminology
Required Experience
Required Experience:
* High school diploma (equivalent combination of education and/or work experience in related field may be substituted)
* Post-secondary education or certification in a related field (preferred)
* 2+ years of related work experience or customer service experience
* 2 years of work experience in healthcare; nursing assistant or medical assistant experience (preferred)
* Candidates must currently reside in Washington DC to be considered
Look forward to hear from you
Sonia Benson
sbenson@nri-staffing.com
NRI, Inc.
Nov 16, 2024