If you have excellent customer service skills.

Some time working in Healthcare.

Excellent computer skills and writing skills.   

Long term contract position, comes with benefits.

Please send your resume to 

sbenson@nri-staffing.com 

Position Type
Full-Time/Regular
• Assist providers to submit documentation of requests for case management, utilization review, and other medical management services.
• Enter documentation of requests for case management, utilization review, and other medical management services (collect/enter information into the system that is limited to non-clinical data or is structured clinical data).
• Convey case information and other notifications via inbound and outbound calls.
• Validate the request submitted via Health Provider Portal for accuracy and completeness.
• Screen cases for required medical information based on type of request, determining if information is sufficient for clinical review
• Obtain clinical information from the client systems when indicated or contact provider to obtain information required for review.
• Process requests after physician review, evaluating language and working with physician reviewers, clinical reviewers, or managers to ensure language and determination information is complete before sending letters to providers
• Respond to inbound telephone requests with clear documentation in the care management system of calls.
• Enter case information from original source documentation or validate information entered by providers in the portal
• Make courtesy calls with case reference numbers.
• Provide notification of completed review and additional information needed, when applicable
• Contribute to orientation and training of other non-clinical employees
• As requested, create templates for complex reviews, perform internal quality reviews, and/or participate in provider outreach activities
• May perform scripted clinical reviews and refer reviews requiring further action to clinical review staff
• After physician review, notify providers of decertification or potential denial of services by phone or in writing as required by contract.
• Complete case after physician review, returning to clinician or sending to client based on procedure
Added accountabilities when performing case management support (as appropriate) include but are not limited to:
• Arrange ancillary authorization requests such as transportation, accommodation
• Obtain customer consent for care management services to be performed
• Correspond with facilities, providers, and others
• Coordinate non-clinical functions and intervention, as directed
• Supervised closure of cases upon completion of review by a clinical reviewer, as directed
Knowledge of the Medicaid eligibility system.
What would make you a strong fit for our role:
• Intermediate understanding of medical terminology
• Intermediate MS Office Suite proficiency
• Demonstrated proficiency with medical terminology
Required Experience
Required Experience:
• High school diploma (equivalent combination of education and/or work experience in related field may be substituted)
• Post-secondary education or certification in a related field (preferred)
• 2+ years of related work experience or customer service experience
• 2 years of work experience in healthcare; nursing assistant or medical assistant experience (preferred)
• Candidates must currently reside in Washington DC to be considered

Look forward to hear from you

Sonia Benson

sbenson@nri-staffing.com