Job Description

Job Description

Job Description

• Maintain a streamlined process for facilitating internal and external medical/peer review requests, including initial case assessment, utilizing applicable utilization management requirements and procedures and guidance from the FHAS Medical Director, as needed. [PRS 2-1.a.i.], [PRS 2-1.a.ii.]
• Respond to any/all client issues/concerns/complaints as quickly as practical to ensure quick resolution.
• Act as a liaison between physicians and clients.
• Review service requests for completeness of information. [PRS 2-2.a.i.]
• Collect and transfer non-clinical data into FHAS’ case management system . [PRS 2-2.a.ii.]
• Acquire structured clinical data. [PRS 2-2.a.iii.]
• Select appropriate medical practitioners and legal professionals to review the cases.
• Draft case summaries and provide references, as applicable.
• Confirm all pertinent peer review issues are thoroughly answered.
• Monitor the reviewers to guarantee there is no conflict of interest and cases are submitted on time.
• Ensure accuracy and timeliness of decisions.
• Complete any/all assigned trainings in TalentLMS and SkillPath.
• Other duties as assigned.

WORK EXPERIENCE REQUIREMENTS

• Background in healthcare and knowledge of CPT, HCPCS, and ICD-10 codes preferred;
• Minimum 4+ years of prior experience;
• Must have strong analytical, verbal, and written communication skills;
• Excellent organizational skills;
• Strong presentation, coaching, and facilitation skills;
• Must be proficient on PC and related software programs including Microsoft Word, Excel, and PowerPoint;
• Ethical, self-motivated and results oriented team player;
• Ability to work independently;
• Travel is not anticipated; however, may be required infrequently.

PHYSICAL REQUIREMENTS

• Must be able to remain in the stationary position 75% of the time;
• Occasionally move about inside the office to access cabinets, office machinery, etc. requiring standing, walking, stooping, kneeling or crouching;
• Constantly operate a computer and other office equipment such as telephone, calculator, copy machine and computer printer;
• Must be physically able to reach with arms and hands and possess finger and wrist dexterity with repetitive motion for typing and writing;
  • Regular & predictable attendance is essential for this position.

Hybrid Position - 3 days in office/ 2 days remote
Day Shift

Job Tags

Work experience placement, Work at office, Remote work, Day shift,

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