Case Reviewer

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🦀 Maryland – Remote

🦀 Maryland – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

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ERM

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

🏥 Healthcare

📦 Logistics

🏭 Manufacturing

Healthcare • Logistics • Manufacturing

ERM is a global leader in sustainability consulting, dedicated to helping businesses tackle their most pressing sustainability challenges. With expertise across various sectors, including chemical, financial services, manufacturing, mining, oil and gas, and renewable energy, ERM provides solutions tailored to ensure compliance with ESG regulations, promote resource efficiency, and support decarbonization efforts. Their services encompass areas like carbon markets, clean energy, health and safety, and environmental management, enabling clients to integrate sustainability into their core operations and strategies.

📋 Description

• Conduct thorough reviews of prior authorization requests to determine medical necessity and compliance with established guidelines and criteria • Assess and manage the appropriateness of healthcare services, ensuring alignment with evidence-based practices and organizational policies • Collaborate with participant supports and internal teams to facilitate communication and resolution of authorization requests • Maintain accurate and detailed records of reviews and decisions in compliance with regulatory requirements and organizational standards • Stay current with changes in medical guidelines, policies, and regulations • Participate in quality improvement initiatives

🎯 Requirements

• Bachelor's degree in a related field • Commitment to staying current with changes in medical guidelines, policies, and regulations • Willingness to participate in ongoing education and training • Experience or interest in participating in quality improvement initiatives • Ability to work effectively with a diverse patient population and colleagues • Strong organizational skills and ability to manage multiple tasks and priorities • Prior Utilization Management knowledge preferred • Familiarity with Home and Community Based Services (HCBS) waiver programs is a plus • Durable Medical Equipment (DME) knowledge is a plus • Good written and oral communication skills required • Typing and data entry skills • Familiarity with computer systems and multiple-monitor work systems • Must be located in Maryland • Quarterly travel to Columbia, MD for training • E-Verify used in hiring practices to achieve a lawful workforce

🏖️ Benefits

• Fully remote work within the US • Quarterly travel to Columbia, MD for training • Ongoing education and training • Equal opportunity and diversity and inclusion commitment • Reasonable accommodation available for individuals with disabilities