Nevada Licensed Clinical Review Coordinator
Job Summary
To ensure timely and accurate case reviews, the full-time Nevada Licensed Clinical Review Coordinator will conduct mandatory quality assurance activities and support physician reviewers while working remotely from the Las Vegas area.
Key responsibilities
- Maintains an efficient case review process and identifies problem areas
- Communicates with physician reviewers by summarizing case facts and preparing inquiries
- Ensures compliance with HIPAA and HITECH regulations while performing desktop medical reviews
Required qualifications
- Graduation from an accredited nursing school with current RN or LPN licensure
- A degree in a healthcare-related field with experience in Medicare QIO
- Two to four years of clinical decision-making experience related to Medicare patients
- Quality of care review or medical review experience supporting Medicare Administrative Contractor (MAC) or Recovery Audit Contractor (RAC) appeals
- Ability to organize and coordinate multiple tasks in a team environment
Complete Job Description
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