Clinical Review Specialist

1 month ago


Somerville, Massachusetts, United States Della Infotech Full time
Join Our Team as a Clinical Review Specialist

At Della Infotech, we are seeking a highly skilled Clinical Review Specialist to join our team. As a key member of our healthcare team, you will play a vital role in ensuring that our members receive the highest quality care.

Key Responsibilities:

  • Utilize clinical knowledge to analyze and assess medical necessity for various healthcare services.
  • Review authorization requests for medical services, including making initial eligibility and coverage determinations.
  • Manage incoming requests for procedures and services, including patient medical records and related clinical information.
  • Collaborate with internal and external stakeholders to ensure seamless communication and effective decision-making.
  • Stay up-to-date with changing regulatory requirements, including Medicare and Medicaid guidelines.

Requirements:

  • Strong knowledge of Medicare and Medicaid regulatory requirements.
  • Excellent clinical review and decision-making skills.
  • Excellent verbal and written communication skills.
  • Ability to work in a fast-paced environment and prioritize multiple tasks.
  • Proficient in Microsoft Office and other relevant software applications.

What We Offer:

  • A competitive salary and benefits package.
  • Opportunities for professional growth and development.
  • A dynamic and supportive work environment.

How to Apply:

Please submit your resume and cover letter to [insert contact information]. We look forward to hearing from you



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