Case Review Manager
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Job Summary
To support timely and accurate case determinations, the full-time Case Review Manager will review incoming case files for completeness, validate system-generated summaries, and perform quality checks on clinician reviews in a fully remote, contract-to-hire role.
Key responsibilities
- Review incoming case files for completeness and accuracy, identifying any missing or inconsistent information
- Validate system-generated summaries against underlying records and escalate discrepancies for clinician review
- Perform final quality assurance on determination letters to ensure clarity and compliance with case-specific requirements
Required qualifications
- Hands-on experience in utilization review, healthcare appeals, or related quality assurance operations
- Ability to critically assess clinical documentation and identify inconsistencies
- Excellent written communication and editing skills for clear and accurate determinations
- Exceptional attention to detail and sound judgment in managing multiple cases
- Bachelor's degree in a healthcare-related field or equivalent relevant experience
Complete Job Description
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