• Case Coordinator

    Requisition ID
    2019-4609
    # of Openings
    1
    Category
    General and Administration
    Location
    US-CA-Santa Monica
  • 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.

    Qualifications

    EDUCATION AND/OR EXPERIENCE

    Active RN or LPN license required. 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.

    Advanced Medical Reviews is an Equal Opportunity Employer and affords equal opportunity to all qualified applicants for all positions without regard to protected veteran status, qualified individuals with disabilities and all individuals without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age or any other status protected under local, state or federal laws.

     

    Equal Opportunity Employer - Minorities/Females/Disabled/Veterans

     

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