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Clinical Reviewer – Remote Jobs in Alabama

Licensed Psychologist Peer Reviewer - Remote
By Optum At , Detroit, 48202
State - specific Medicaid services (e.g. Psychosocial Rehabilitation, Targeted Case Management, Home Based Habilitation, Supported Employment, etc.)
Experience working in a managed care setting
3+ years of post - licensure experience
Computer skills, including facility with Windows OS, Outlook, Word, Teams and Excel
ASPPB Certificate of Professional Qualification (CPQ)
Experience with Commercial, Medicaid and Medicare lines of business
A&G Clinical Coordinator - 100% Remote
By Healthfirst At Georgia, United States
Complete all associated data entry and authorization creation in the True care system.
Knowledge of related NY state and federal regulations highly desirable
Knowledge of the New York state ART 44 PHL and federal regulatory environment
Knowledge of claims payment process and claims data system (MHS)
Prepare cases for the clinical team by gathering documentation, loading evidence, and making calls to members and providers.
Perform administrative activities including but not limited to generating and printing determination and authorization notification letters.

Are you looking for an exciting opportunity to use your clinical expertise to make a difference in the healthcare industry? We are looking for a Clinical Reviewer to join our remote team and help us ensure the highest quality of care for our patients. As a Clinical Reviewer, you will be responsible for reviewing medical records and making sure they meet the standards of our organization. You will also be responsible for identifying any potential issues and making recommendations for improvement. If you are passionate about healthcare and have the skills to make a difference, then this is the job for you!

Overview Clinical Reviewer – Remote is a position that involves reviewing medical records and other clinical data to ensure accuracy and compliance with applicable regulations. The Clinical Reviewer will be responsible for assessing the quality of care provided to patients, identifying any potential risks or issues, and providing recommendations for improvement. The Clinical Reviewer will also be responsible for providing feedback to providers and other stakeholders on the quality of care provided. Detailed Job Description The Clinical Reviewer – Remote is responsible for reviewing medical records and other clinical data to ensure accuracy and compliance with applicable regulations. The Clinical Reviewer will assess the quality of care provided to patients, identify any potential risks or issues, and provide recommendations for improvement. The Clinical Reviewer will also provide feedback to providers and other stakeholders on the quality of care provided. The Clinical Reviewer will be responsible for ensuring that all medical records are accurate and up-to-date, and that all clinical data is collected and stored in accordance with applicable regulations. The Clinical Reviewer will also be responsible for monitoring and evaluating the performance of providers and other stakeholders, and providing feedback on any areas of improvement. Job Skills Required
• Knowledge of medical terminology and clinical data
• Knowledge of applicable regulations and standards
• Ability to analyze and interpret medical records and other clinical data
• Ability to identify potential risks and issues
• Ability to provide feedback and recommendations for improvement
• Excellent communication and interpersonal skills
• Strong organizational and time management skills
• Ability to work independently and as part of a team
Job Qualifications
• Bachelor’s degree in a related field
• At least 3 years of experience in a clinical setting
• Certification in a related field (e.g. CCS, CPC, etc.)
• Knowledge of medical terminology and clinical data
• Knowledge of applicable regulations and standards
• Ability to analyze and interpret medical records and other clinical data
• Ability to identify potential risks and issues
• Excellent communication and interpersonal skills
Job Knowledge
• Knowledge of medical terminology and clinical data
• Knowledge of applicable regulations and standards
• Ability to analyze and interpret medical records and other clinical data
• Ability to identify potential risks and issues
• Knowledge of quality assurance and improvement processes
Job Experience
• At least 3 years of experience in a clinical setting
• Experience in medical record review and analysis
• Experience in providing feedback and recommendations for improvement
• Experience in monitoring