Clinical Review Coordinator

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🕒 2 days ago

🎰 Nevada – Remote

🎰 Nevada – Remote

💵 $60k - $83.2k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

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LivantaLLC

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 2004

🏥 Healthcare

💼 Consulting

⚕️ Healthcare Insurance

Healthcare • Consulting • Healthcare Insurance

Livanta LLC is a technology-enabled organization dedicated to advancing healthcare quality through innovation. It specializes in providing services to patients, caregivers, healthcare providers, and payers, focusing on improving health outcomes, navigating healthcare systems, and ensuring payment accuracy. Livanta is recognized as the largest Medicare Quality Improvement Organization and offers a range of services including quality oversight, auditing, advocacy, and data analytics to enhance patient care and safety while managing healthcare costs effectively.

📋 Description

• Conduct mandatory case reviews and quality assurance activities required by contracts • Maintain timeliness and accuracy throughout the case review process • Assure an efficient case review process through the production system • Identify and correct case-level and system-wide problem areas • Interpret and apply coverage and payment policies, standards of care, and utilization review criteria • Support physician reviewers by summarizing case facts, preparing case questions, and resolving physician input issues • Inform Medicare beneficiaries, healthcare providers, and partners about QIO activities and responsibilities • Edit documentation for internal and external dissemination • Protect patient information in compliance with HIPAA and HITECH • Perform desktop medical reviews • Act as a neutral liaison for beneficiaries and representatives, as assigned • Navigate beneficiaries through the healthcare system and provide education, advocacy, resource access, and targeted support • Develop and maintain relationships with community agencies • Educate beneficiaries about diagnoses and Medicare patient rights and responsibilities • Schedule staff for the Medicare Beneficiary Helpline during work hours, as assigned • Collaborate with internal and external QIO staff on healthcare improvement projects • Perform other duties as assigned

🎯 Requirements

• Reside in the Las Vegas, NV area • Detailed-oriented and clinically knowledgeable in medical terminology • Graduation from an accredited school of nursing • Current unrestricted Registered Nurse (RN) or Licensed Practical Nurse (LPN) licensure recognized in the relevant jurisdiction • Healthcare-related degree with a professional clinical background and Medicare QIO experience • Quality of care review or medical review experience supporting Medicare Administrative Contractor (MAC) or Recovery Audit Contractor (RAC) appeals • Experience performing pre- and post-pay claims reviews and utilization reviews may qualify • Two to four years of experience in clinical decision-making relative to Medicare patients • Notify a Livanta HR Manager in writing within five calendar days of any status change or disciplinary proceeding relating to licenses or certifications • Ability to organize and coordinate multiple simultaneous tasks in a team environment • Ability to follow complex written and oral instructions • Ability to collect data, distinguish relevant material, and exercise sound judgment • Problem-solving skills and objectivity • Strong computer keyboarding skills • Ability to work independently with minimal supervision • Accurate, consistent, timely, clear, empathetic, respectful, and effective verbal and written communication • Ability to work varying schedules, including weekend and holiday shifts • Ability to sit, read, work on a computer, and watch a computer screen for extended periods • Ability to occasionally stand, walk, use hands and fingers, kneel, or crouch

🏖️ Benefits

• Remote work • Reasonable accommodations for individuals with disabilities • Annual security awareness, rules of conduct, and conflict of interest training • Equal employment opportunity and merit-based personnel processes