Medical Review Case Coordinator

2 weeks ago

Schertz, Texas, United States Nexus Full time
Job Overview

Position Summary:

The Case Fulfillment Coordinator is a pivotal administrative role focused on delivering exceptional customer service to our clients. The ideal candidate will exhibit a friendly demeanor, efficiency, and a strong attention to detail. This role demands proficiency in planning, organizing, and overseeing the completion of independent medical reviews, alongside managing daily office operations. The individual will collaborate closely with physician reviewers, addressing their administrative needs effectively. This position thrives in a team-oriented environment and requires critical thinking skills, the ability to work under pressure, and a commitment to meeting deadlines.

Key Responsibilities:

  • Oversee all administrative aspects of the fulfillment workflow for Utilization Review referrals.
  • Coordinate and route referrals for prior authorization, concurrent review, and retrospective review within the Utilization Review sector.
  • Exercise discretion and independent judgment in managing documents received from patients or physicians, directing them to the appropriate administrative or clinical staff.
  • Maintain open communication with physician reviewers regarding daily administrative tasks.
  • Assist physicians in adhering to time-sensitive deadlines.
  • Ensure compliance with all state, federal, and referral/intake regulatory requirements for Utilization Review.
  • Manage the administrative Quality Assurance process, including templates and completed fields.
  • Adhere to template standards for each client.
  • Notify the Director of Operations of any referrals that deviate from standardized processes.
  • Facilitate the timely transition of completed reviews to clients.
  • Act as the primary contact for incoming communications related to Case Fulfillment.
  • Ensure compliance with jurisdictional case requirements and specialty requirements.
  • Prioritize workflow and assign due dates for physician panel tasks.
  • Handle a daily case load of at least 75 cases.
  • Utilize web-based portal applications effectively.
  • Maintain organized documentation logs for assigned physician reviewers.
  • Provide basic information and manage incoming calls related to Case Fulfillment.
  • Demonstrate resourcefulness and proactivity in addressing issues in collaboration with the team and Director of Operations.
  • Uphold security protocols by following procedures and controlling access (HIPAA compliance).
  • Support team members in a collaborative environment.
  • The responsibilities outlined above are intended to provide a representative summary of the major duties performed by individuals in this role. Additional job-related tasks may be assigned as necessary.

Qualifications:

  • Consistent punctuality and readiness to work each day.
  • Proficient use of computers, printers, fax machines, and telephones in a professional setting.
  • Typing skills of at least 65 words per minute.
  • Data entry skills with a speed of 5,000 kph for numeric and 10,000 kph for alphanumeric data.
  • Professional communication skills with physicians and clients.
  • Ability to multitask and perform efficiently under time-sensitive conditions.
  • Familiarity with Microsoft Office Suite (2003 or later).
  • Willingness to seek assistance when needed.
  • Supportive of team dynamics and organizational flow.
  • Adhere to confidentiality agreements and company policies.

Disclaimer:

The statements above are intended to describe the general nature and level of work performed by individuals in this classification. They are not exhaustive lists of all responsibilities, duties, and skills required of personnel. Employees may be required to perform duties outside of their normal responsibilities as needed.

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