Employer Industry: Healthcare Services

Why consider this job opportunity:
- Contract position with potential for extension
- Salary offers competitive pay in the healthcare industry
- Opportunity for career advancement and growth within the organization
- Work remotely from one of the 28 approved states
- Supportive and collaborative work environment
- Comprehensive training provided for the role

What to Expect (Job Responsibilities):
- Conduct non-clinical reviews based on applicable criteria and guidelines for requested services
- Document outcomes of reviews and analyze non-clinical information
- Perform outreach to providers or members to gather necessary medical information for reviews
- Identify and refer cases requiring clinical review to appropriate medical personnel
- Support care management by meeting CMS requirements through member and provider outreach

What is Required (Qualifications):
- High school diploma or GED
- Minimum of 3 years of experience in a related field
- Strong customer service skills with attention to detail
- Proficiency in Microsoft Suite
- Ability to manage calls effectively and de-escalate when necessary

How to Stand Out (Preferred Qualifications):
- Experience in the medical or healthcare industry
- Familiarity with software such as Nuxeo, Genesys, Care Radius, or Facets

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