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Clinical Review Specialist

2 months ago


Lancaster, Pennsylvania, United States High Desert Medical Group Full time

Clinical Services Reviewer

**Job Summary**

High Desert Medical Group is seeking a skilled Clinical Services Reviewer to join our team. As a Clinical Services Reviewer, you will be responsible for reviewing requests for clinical services to ensure they meet health plan and CMS guidelines. Your expertise in managed care, Medicare, and Medi-Cal will be essential in making determinations on requests for clinical services.

**Key Responsibilities**

* Review requests for clinical care appropriateness
* Defer potential denials to MD and other duties as assigned
* Utilize excellent computer skills and typing abilities to efficiently complete tasks
* Possess knowledge of health plan and CMS guidelines

**Requirements**

* Managed care background
* Knowledge of Medicare and Medi-Cal
* Excellent computer skills and typing abilities
* Ability to review and make determinations on requests for clinical services

**What We Offer**

* Competitive salary and benefits package
* Opportunity to work with a reputable healthcare organization
* Collaborative and dynamic work environment

**How to Apply**

If you are a motivated and detail-oriented individual with a passion for clinical services, we encourage you to apply for this exciting opportunity. Please submit your resume and cover letter to [insert contact information].