Job Description
As the Clinical Reviewer, you will be responsible for the review and processing of all requests for Independent Reviews from External Agencies in accordance with contractual guidelines. Upon receipt of the electronic medical records, communicate with contractors, providers and beneficiary/representatives. Duties include but are not limited to: Performing case reviews utilizing regulatory guidelines criteria and clinical knowledge for medical necessity and quality of care issues; formulate a case summary and the review questions for the Physician Reviewer based upon the External Agency’s concern(s), reviewing physician determinations, ensuring all categories of concern have been addressed and preparing written correspondences to contractors, providers and beneficiaries/representatives.
This is a full-time position based in the Jericho, NY office. Ability to work remotely one day per week after introduction period .
QUALIFICATIONS:
EDUCATION & EXPERINCE:
The salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. The hourly range for this position is $38.46 – $43.27. Actual salary range and /or hourly rate depends on a variety of factors including experience, education, credentials, location, and budget.
The salary range and/or hourly rate listed does not include other forms of compensation or benefits.
IPRO is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, disability, protected veteran status or military status, or any other category protected under applicable law.
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