Simsy Ventures
11 - 50 employees
Founded 2022
💼 Consulting
📣 Marketing
🏥 Healthcare
Consulting • Marketing • Healthcare
Simsy Ventures is a venture builder and institutional co-founder that partners with entrepreneurs, investors, and corporations to create sustainable startups. Their mission focuses on enabling startups to achieve true potential while promoting a positive impact on profits, people, and the planet. With a structured approach, they support startups throughout their lifecycle, from ideation to market validation and growth. By leveraging a repeatable venture studio model, Simsy Ventures aims to uplift economies globally through impactful entrepreneurship.
Clinical Reviewer – Utilization Review
Job not on LinkedIn
🔥 2 minutes ago
🇺🇸 United States – Remote
💵 $65k / year
⏰ Full Time
🟢 Junior
🟡 Mid-level
🔍🏥 Medical Reviewer
👻 Ghost score 0%
Where this job comes from
Posted on Simsy Ventures's careers page, not through a job board
First seen by Remote Rocketship 2 minutes ago
Simsy Ventures
11 - 50 employees
Founded 2022
💼 Consulting
📣 Marketing
🏥 Healthcare
Consulting • Marketing • Healthcare
Simsy Ventures is a venture builder and institutional co-founder that partners with entrepreneurs, investors, and corporations to create sustainable startups. Their mission focuses on enabling startups to achieve true potential while promoting a positive impact on profits, people, and the planet. With a structured approach, they support startups throughout their lifecycle, from ideation to market validation and growth. By leveraging a repeatable venture studio model, Simsy Ventures aims to uplift economies globally through impactful entrepreneurship.
📋 Description
• Conduct comprehensive reviews of home health pre-claim review packages for Medicare coverage, coding, and payment compliance • Document affirmation/non-affirmation outcomes with clinical rationale in the case management system within 7 business days • Engage with providers to request or clarify documentation when authorized • Escalate provider concerns or suspected fraud according to program procedures • Maintain 98% accuracy • Complete required training, quality assurance reviews, and inter-rater reliability sessions
🎯 Requirements
• Active, unrestricted RN license in the candidate's state of residence • Minimum of 2 years of clinical experience • At least 2 years of experience in home health, quality assurance, or utilization review • Candidates must live in and work from an eligible U.S. state when hired and throughout employment • Experience in home health (OASIS, Medicare Conditions of Participation) or prior involvement with MAC/RCD/CMS program integrity (preferred) • Proficiency in ICD coding (preferred) • Successful completion of background checks and drug testing prior to employment; some positions may require fingerprinting
🏖️ Benefits
• 401(k) and company match • PTO that grows the longer you stay • Health, Vision, Dental • Company provided Life Insurance and Voluntary Life Insurance • Short Term Disability and Long Term Disability
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