Altum Solutions Medical Reviewer Cayce, SC · Full time

We are currently seeking a qualified Medical Reviewer for a contract role with our prestigious client. This position offers a competitive hourly rate of $28/hr and is mainly remote, with training taking place onsite.

Description

Job Details:


  • Number of Positions: 1
  • Location: Columbia, South Carolina (training will take place onsite, then may work remotely)
  • Duration: 12/4/23 - 3/10/24 with possible extension/conversion
  • Pay: $24/hr


Job Description:

The Reviewer I, Medical will be responsible for conducting medical reviews based on established criteria, and managing the utilization of professional, inpatient, and outpatient facility benefits or services. This position also offers ample room for growth and opportunities to participate in quality control activities.


Key Dutities:


  • Medical Review & Claims Management (80%)
  • Performs medical reviews and documentation
  • Manages the authorization process
  • Conducts high-dollar forecasting research
  • Reviews first-level appeals
  • Education & Documentation (10%)
  • Educates internal and external stakeholders
  • Maintains thorough and timely documentation
  • Quality Control & Training (10%)
  • Participates in quality control activities
  • Engages in ongoing required training


Skills and Requirements:

Required:


  • Bachelor's degree in Social Work OR accredited LPN/LVN
  • 2 years of clinical experience
  • Active, unrestricted LPN/LVN or LBSW licensure in the United States and in the state of hire
  • Proficiency in Microsoft Office
  • Strong analytical skills and good judgment
  • Demonstrated customer service and organizational skills
  • Ability to handle confidential information with discretion

Preferred:


  • Associate Degree in Nursing or Graduate of an Accredited School of Nursing
  • Active, unrestricted RN licensure in the United States and in the state of hire
  • Proficiency in Microsoft Excel, Access
  • Ability to work independently and prioritize effectively
  • Experience in case management or care coordination


Language Requirement:


  • English (Speak, Read, Write)


What We Offer:


  • Opportunity for contract to hire
  • Comprehensive training
  • Remote work options after training


What A Typical Day Looks Like:

You will be managing a caseload of members telephonically, coordinating care, and assisting with triage when needed.


About Our Team:

Our team consists of a diverse group of healthcare professionals who work closely together to manage the healthcare needs of our members.

Preferred Qualities:


  • Strong communication skills
  • Active listening abilities
  • Effective time management

Note:

We are not looking for candidates with limited clinical experience.



Schedule Notes:


  • Partially Onsite (Mainly Remote, but will need to be onsite for training)
  • Work hours: 8 am to 5 pm Monday to Friday
  • Hours Per Week: 40.00
  • Hours Per Day: 8.00


Salary

$20 - $24 per hour