Nevada Licensed Clinical Review Coordinator

Job Summary

A company is looking for a Clinical Review Coordinator.

Key Responsibilities

• Conducts mandatory case reviews and quality assurance activities while ensuring timeliness and accuracy
• Communicates with physician reviewers and supports them by summarizing case facts and resolving input issues
• Protects patient confidentiality and ensures compliance with HIPAA and HITECH regulations

Required Qualifications, Training, and Education

• Graduation from an accredited nursing school and current unrestricted licensure as an RN or LPN
• A degree in a healthcare-related field with experience in Medicare QIO
• Quality of care review or medical review experience related to Medicare Administrative Contractor appeals
• Minimum of two to four years of clinical decision-making experience with Medicare patients
• Licensure must be recognized in the relevant jurisdiction for the assigned work