Maine Licensed Clinical Review Specialist

Job Summary

A company is looking for a Clinical Review Specialist to conduct utilization management reviews and provide clinical information to confirm patient coverage.

Key Responsibilities:

• Apply clinical expertise in reviewing therapy checklists and authorization forms to ensure quality care
• Maintain understanding of regulations and serve as a subject matter expert on specialty drugs
• Communicate coverage decisions and resolve issues with internal and external stakeholders

Required Qualifications:

• Medical Assistant certification required
• Healthcare experience in a medical setting required
• Associate of Arts degree or higher preferred
• Experience in care coordination or home infusion preferred
• Working knowledge of federal/state fraud and abuse laws required