[Hiring] Clinical Review Specialist @New England Life Care

Role Description

The Clinical Review Specialist will conduct regular utilization management reviews and provide clinical information as required in order to confirm coverage for each patient.

Qualifications

• Medical Assistant certification required
• MA or LPD preferred
• Associate of Arts degree or higher preferred
• Healthcare experience in a medical setting required
• Prior experience in care coordination, home health or home infusion preferred
• Experience in managed care environment
• Experience in working with established criteria to determine medical necessity and appropriateness of care
• Experience in utilization review, utilization management, quality review
• Working knowledge of federal/state fraud and abuse laws required
• Knowledge of HIPAA Privacy and Security Regulations preferred

Requirements

• Dependability in attendance and job performance required
• Excellent verbal and written communication and interpersonal skills
• Excellent problem identification and solving skills
• Ability to organize and prioritize multiple assignments within workload
• Ability to function independently and take independent action, within scope of job responsibilities
• Competency in computer skills including Microsoft Word, Outlook, and internet

Benefits

• Career Ladder
• Health insurance
• Dental insurance
• Vision insurance
• Generous employer-matched 403(b) savings program
• Company paid: Life insurance, Short- and long-term disability insurance
• Paid Time Off
• And much more!