Case Coordinator

US-CA-Santa Monica

Advanced Medical Reviews

Req #: 2240
Type: Regular Full-Time
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Advanced Medical Reviews

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				Overview:

The Case Coordinator is responsible to ensure reports are of the highest quality and integrity and in full compliance with client contractual agreement, regulatory agency standards and/or federal and state mandates. This position is required to assist with quality assurance questions and provide overall support to the Quality Assurance Department. 

Responsibilities:

ESSENTIAL DUTIES AND RESPONSIBILITIES TO PERFORM THIS JOB SUCCESSFULLY INCLUDE, BUT ARE NOT LIMITED TO THE FOLLOWING:

* Performs quality assurance review of reports, correspondences, addendums or supplemental reviews.
* Ensures clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinations.
* Ensures that all client instructions and specifications have been followed and that all questions have been addressed.
* Ensures each review is supported by clinical citations and references when applicable and verifies that all references cited are current and obtained from reputable medical journals and/or publications.
* Ensures the content, format, and professional appearance of the reports are of the highest quality and in compliance with company standards.
* Ensure that the appropriate board specialty has reviewed the case in compliance with client specifications and/or state mandates and is documented accurately on the case report.
* Verifies that the peer reviewer has attested to only the fact(s) and that no evidence of reviewer conflict of interest exists.
* Ensures the provider credentials and signature are adhered to the final report.
* Identifies any inconsistencies within the report and contacts the Peer Reviewer to obtain clarification, modification or correction as needed.
* Assists in resolution of customer complaints and quality assurance issues as needed.
* Ensures all federal ERISA and/or state mandates are adhered to at all times.
* Provides insight and direction to management on consultant quality, availability and compliance with all company policies and procedures and client specifications.
* Promote effective and efficient utilization of company resources.
* Participate in various educational and or training activities as required.
* Perform other duties as assigned.

Qualifications:

EDUCATION AND/OR EXPERIENCE

High school diploma or equivalent required. A minimum of two years clinical or related field experience; or equivalent combination of education and experience. Knowledge of the insurance industry preferably claims management relative to one or more of the following categories: workers' compensation, no-fault, liability, and/or disability.

QUALIFICATIONS 

* Must have strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values.
* Must be able to add, subtract, multiply, and divide in all units of measure, using whole numbers and decimals; Ability to compute rates and percentages.
* Must be a qualified typist with a minimum of 40 W.P.M
* Must be able to operate a general computer, fax, copier, scanner, and telephone.
* Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet.
* Must possess excellent skills in English usage, grammar, punctuation and style.
* Ability to follow instructions and respond to upper managements' directions accurately.
* Demonstrates accuracy and thoroughness. Looks for ways to improve and promote quality and monitors own work to ensure quality is met.
* Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed.
* Must be able to work independently, prioritize work activities and use time efficiently.
* Must be able to maintain confidentiality.
* Must be able to demonstrate and promote a positive team -oriented environment.
* Must be able to stay focused and concentrate under normal or heavy distractions.
* Must be able to work well under pressure and or stressful conditions.
* Must possess the ability to manage change, delays, or unexpected events appropriately.
* Demonstrates reliability and abides by the company attendance policy.
* Must maintain a professional and clean appearance at all times consistent with company standards.
			
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