Clinical Reviewer / Care Manager
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Job Description
Clinical Reviewer managing data collection and communications for patient reviews at Phelps Health. Responsible for authorizations and reviews for Medicare and other third party payers.
Responsibilities:
- Assists with data collection, entry and generation of reports
- Coordinates communication between Patient Financial Services, Third party Payers, patients, and physicians
- Performs certifications, authorizations, concurrent reviews, and appeals
- Reviews inpatient and observation patients for Medicare, Medicaid, Commercial, and Medicare HMO third party payers.
Requirements:
- Graduate of an approved practical nursing program or an equivalent combination of education and experience
- At least two (2) years clinical experience in Utilization Management, Social Services, and/or Quality Management required
- Experience working with third party payers is preferred.
Benefits:
- At Phelps Health, we think we have a better team, benefits, and opportunities for growth than anyone else around.
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