Clinical Review Specialist
3 weeks ago
**Job Summary**
We are seeking a highly skilled Clinical Review Specialist to join our team at Della Infotech. As a Clinical Review Specialist, you will play a critical role in ensuring the quality and integrity of our clinical review processes.
**Key Responsibilities**
* Strong knowledge of Medicare regulatory requirements, including Local Coverage Determinations (LCDs) and National Coverage Determinations (NCDs)
* Expertise in clinical review for prospective, concurrent, retrospective utilization management reviews utilizing Interqual, company policies and procedures, and other resources as determined by review
* Review authorization requests for medical services, including making initial eligibility and coverage determinations, screening for medical necessity appropriateness, determining if additional information is required, and referral to correct programs within Mass General Brigham Health Plan as needed
* Manage incoming requests for procedures and services, including patient medical records and related clinical information
* Adherence to program, departmental and organizational performance metrics, including productivity
* Excellent verbal and written communication skills
* Excellent problem-solving and customer service skills
* Ability to work in a fast-paced environment and adapt to changing priorities
**Requirements**
* Bachelor's degree in a related field
* 2+ years of experience in clinical review or a related field
* Strong knowledge of Medicare and Medicaid regulatory requirements
* Excellent analytical and problem-solving skills
* Ability to work independently and as part of a team
**What We Offer**
* Competitive salary and benefits package
* Opportunities for professional growth and development
* Collaborative and dynamic work environment
**How to Apply**
If you are a motivated and detail-oriented individual with a passion for clinical review, please submit your application, including your resume and cover letter, to [insert contact information]. We look forward to hearing from you
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