Clinical Review Specialist

Job Summary

A company is looking for a Clinical Review Specialist, Remote.

Key Responsibilities

• Conducts pre-visit reviews of ambulatory encounters to identify and recapture medical conditions as HCC diagnoses
• Educates providers on diagnostic specificity and presents clear communication regarding HCC considerations
• Maintains professional competency and fosters collaborative relationships with the clinical care team

Required Qualifications

• 3-5 years of experience in case management, outpatient coding, utilization review, or similar fields
• Preferred 2 years of experience in Primary Care, medical coding, risk adjustment, or CDI
• Preferred current certification in Clinical Documentation Improvement or medical coding
• Preferred medical licensure (RN, PA, NP) and a healthcare-related Bachelor's degree
• Strong PC skills, including proficiency in Microsoft applications