Massachusetts Licensed Clinical Review Specialist

Job Summary

To support a growing home infusion therapy company, the full-time Massachusetts Licensed Clinical Review Specialist will conduct utilization management reviews and provide clinical information to confirm patient coverage, working remotely with a schedule of Monday to Friday from 8:30 am to 5:00 pm.

Key responsibilities:

• Apply clinical expertise to review therapy checklists and authorization forms, ensuring high-quality, cost-effective care
• Maintain comprehensive knowledge of regulations, payer contracts, and internal policies to ensure compliance
• Communicate coverage decisions effectively to members and providers, adhering to established timelines and standards

Required qualifications:

• Medical Assistant certification is required
• Healthcare experience in a medical setting is required
• Prior experience in care coordination, home health, or home infusion is preferred
• Working knowledge of federal/state fraud and abuse laws is required
• Knowledge of HIPAA Privacy and Security Regulations is preferred