Clinical Review Coordinator

Job not on LinkedIn

🕒 August 7

🎰 Nevada – Remote

🎰 Nevada – Remote

💵 $60k - $83.2k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

👻 Ghost score 16%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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 review process • Manage an efficient case review process through the production system • Identify and correct case-specific 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 other partners about QIO activities and responsibilities • Edit documentation for internal and external dissemination • Protect patient information through HIPAA and HITECH compliance • Perform desktop medical reviews • Attend annual security awareness, rules of conduct, and conflict of interest training • Serve as a neutral liaison for beneficiaries and representatives, depending on departmental assignment • Navigate beneficiaries through the healthcare system • Provide education, advocacy, resource access, and targeted support to reduce readmissions • Develop and maintain relationships with community agencies • Assist beneficiaries in understanding diagnoses • Inform beneficiaries and interested parties of Medicare patient rights and responsibilities • Schedule staff for the Medicare Beneficiary Helpline • Collaborate with internal and external QIO staff on healthcare improvement projects • Perform other duties as assigned

🎯 Requirements

• Must reside in the Las Vegas, NV area • Graduation from an accredited school of nursing • Current unrestricted licensure as a Registered Nurse (RN) or Licensed Practical Nurse (LPN), recognized in the jurisdiction relevant to the assigned work • Degree in a healthcare-related field with a professional clinical background and experience with Medicare QIO • Quality of care review experience 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 also qualify • Minimum of two to four years of experience in clinical decision-making relative to Medicare patients • Detailed-oriented and clinically knowledgeable of medical terminology • 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 • Ability to apply problem-solving skills and maintain objectivity • Strong computer keyboarding skills • Ability to work independently with minimal supervision • Ability to communicate accurately, consistently, timely, clearly, empathetically, respectfully, and effectively with beneficiaries, representatives, and providers, verbally and in writing • Ability to work variable schedules, including weekend and holiday shifts • Ability to sit, read, work on a computer, and watch a computer screen for extended periods • Occasional ability to stand, walk, use hands and fingers, kneel, or crouch • Must notify a Livanta HR Manager in writing within five calendar days of any status change or disciplinary proceeding relating to licenses or certifications

🏖️ Benefits

• Remote work • Reasonable accommodations for individuals with disabilities • Equal employment opportunity and nondiscrimination • Climate-controlled work environment • Annual security awareness, rules of conduct, and conflict of interest training