Case Coordinator Jobs

Overview
Advanced Medical Reviews (AMR) is seeking a detailed oriented and extremely organized professional for our Case Coordinator role.
The Case Coordinator is responsible or ensuring reports are of the highest quality and integrity and in full compliance with client contractual agreement, regulatory agency standards and/or federal and state mandates. This position is required to assist with quality assurance questions and provide overall support to the Quality Assurance Department.
This position is 100% remote and the schedule will be Monday – Friday, 9-6pm PST.
Responsibilities

• Ensures that all client instructions and specifications have been followed and that all questions have been addressed.
• Assists in resolution of customer complaints and quality assurance issues as needed.
• Ensures each review is supported by clinical citations and references when applicable and verifies that all references cited are current and obtained from reputable medical journals and/or publications.
• Ensures the content, format, and professional appearance of the reports are of the highest quality and in compliance with company standards.
• Ensures all federal ERISA and/or state mandates are adhered to at all times.
• Performs quality assurance review of reports, correspondences, addendums or supplemental reviews.
• Ensure that the appropriate board specialty has reviewed the case in compliance with client specifications and/or state mandates and is documented accurately on the case report.
• Verifies that the peer reviewer has attested to only the fact(s) and that no evidence of reviewer conflict of interest exists.
• Ensures clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinations.
• Identifies any inconsistencies within the report and contacts the Peer Reviewer to obtain clarification, modification or correction as needed.
• Perform other duties as assigned.
• Participate in various educational and or training activities as required.
• Ensures the provider credentials and signature are adhered to the final report.
• Provides insight and direction to management on consultant quality, availability and compliance with all company policies and procedures and client specifications.
• Promote effective and efficient utilization of company resources.

Qualifications
High school diploma or equivalent required. A minimum of two years clinical or related field experience; or equivalent combination of education and experience. Knowledge of the insurance industry preferably claims management relative to one or more of the following categories: workers' compensation, no-fault, liability, and/or disability.

• Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet.
• Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed.
• Ability to follow instructions and respond to upper managements’ directions accurately.
• Must have strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values.
• Must maintain a professional and clean appearance at all times consistent with company standards.
• Demonstrates accuracy and thoroughness. Looks for ways to improve and promote quality and monitors own work to ensure quality is met.
• Must be able to work well under pressure and or stressful conditions.
• Must possess the ability to manage change, delays, or unexpected events appropriately.
• Must be able to work independently, prioritize work activities and use time efficiently.
• Must be able to stay focused and concentrate under normal or heavy distractions.
• Must be able to add, subtract, multiply, and divide in all units of measure, using whole numbers and decimals; Ability to compute rates and percentages.
• Must be able to maintain confidentiality.
• Must be able to operate a general computer, fax, copier, scanner, and telephone.
• Must be a qualified typist with a minimum of 40 W.P.M
• Demonstrates reliability and abides by the company attendance policy.
• Must possess excellent skills in English usage, grammar, punctuation and style.
• Must be able to demonstrate and promote a positive team -oriented environment.

Founded in 2004, AMR is setting the industry standard in providing quality independent medical case review and utilization management services that are timely, customizable and affordable. AMR offers a single source solution for all of our clients' review and utilization management needs covering all specialties and subspecialties nationwide. Our highly trained compliance staff and specialized case review nurses are bolstered by a strong quality assurance process guaranteeing the highest quality standards throughout the review process. Our commitment is to our clients and their patients. We emphasize - throughout all the work that we do - continuous quality improvement, innovation and client satisfaction.
Advanced Medical Reviews is an Equal Opportunity Employer and affords equal opportunity to all qualified applicants for all positions without regard to protected veteran status, qualified individuals with disabilities and all individuals without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age or any other status protected under local, state or federal laws.
Equal Opportunity Employer - Minorities/Females/Disabled/Veterans