Medical Reviewer

• Act as team lead for specialty programs, medical review, utilization management, and case management areas
• Provide assistance and support to the unit supervisor/manager
• Give direction, guidance, and training to staff
• Ensure appropriate levels of healthcare services are provided
• Function as a team leader/senior-level Medical Reviewer
• Maintain working knowledge of unit functions, department inner workings, and workflow
• Serve as a resource for staff and external entities by troubleshooting and resolving issues
• Keep the manager informed of problems and issues requiring resolution
• Assist management with monitoring workflow and workloads
• Reassign work and redirect work intake sources to balance workloads and meet timelines
• Monitor reporting and address aging issues
• Participate in departmental quality reviews and ensure adherence to the quality plan
• Give and receive feedback regarding medical review decision-making and technical claims processing issues
• Ensure quality work instructions, forms, and documents are developed or revised as needed
• Provide quality service and communicate effectively with internal and external customers
• Obtain information from internal departments, providers, government, and private agencies to resolve discrepancies and problems
• Participate in compliance initiatives, directed activities, and special projects as requested by management
• Work Monday-Friday, 40 hours per week, during 8:00am-4:30pm or 8:30am-5:00pm schedules

Medical Reviewer jobs in South Carolina

Senior Medical Reviewer