This page tracks remote medical writer openings that are location-eligible for Florida.
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Fairview Health Services is a healthcare nonprofit that provides various health services, including primary care, specialized medical treatment, mental health s
Role Description Fairview has an exciting opportunity for a RN Clinic Specialist to join our Endoscopy Support team. This role is a 0.8 FTE (64 hours per 2-week pay period) on the day shift and is 100% remote, offering the flexibility to work from home while staying connected to a collaborative clinical team. Hours are generally 8:00am-4:30pm or 8:30am-5pm with regularly scheduled time off on Tuesdays. We’re proud to support a healthy work–life balance, with a predictable daytime schedule, reduced FTE for added flexibility, and a remote work environment designed to help you thrive both professionally and personally. This position is ideal for an experienced nurse who values meaningful work, team connection, and the ability to maintain balance outside of work. This specialized Registered Nurse performs both independent nursing and delegated medical functions: - Independent nursing includes assessment, planning, delivery, and evaluation of nursing care for assigned patient population(s) usually in specialty or acute care clinics. - Delegated medical function includes participation in and coordination of delegated patient care to other health care team members. - Responsible for performing these functions in accordance with all policy, procedure, and professional practice guidelines. - Assists provider with complex procedures and independently completes a variety of tasks including, but not limited to: - Injections - Phone triage - Preparation of education materials - Patient education - Patient vital checks - Chart documentation - Monitors standards of care - Keeps up to date on technological advances and new pharmaceutical products. Core Accountabilities: - Assesses patient needs and identifies expected nursing outcomes. - Implements nursing interventions based on plan of care. - Evaluates care and the patient’s response to interventions and expected outcomes. - Delivers care as delegated by physician/authorized practitioner to assigned patient population, or individual patient. - Uses communication strategies to achieve desirable outcomes. - Demonstrates ability to provide care or service adjusting approaches to reflect developmental level of population served. - Performs other duties including Performance Goals developed by manager and employee and reported in the employee’s Performance Review. Qualifications - Associate’s (ADN) or Bachelor’s Degree in Nursing (BSN) preferred. - BLS Certification. - Prefer at least 1 year GI or Endoscopy experience. - Prefer 5 years of hospital or clinic experience, or 2 years of specialty/critical care experience with specialty certification. - Ability to keyboard and utilize computer applications. Benefits - Generous benefit package including but not limited to: - Medical, dental, vision plans - Life insurance - Short-term and long-term disability insurance - PTO and Sick and Safe Time - Tuition reimbursement - Retirement - Early access to earned wages - And more! Company Description Please follow this link for additional information: Fairview Benefits
Together with our customers, we are driven to make healthcare better. #WeAreStryker
Role Description In this role, you will serve as a key resource, educating healthcare professionals, academic partners, and internal stakeholders on product-related information and clinical developments. The ideal candidate will bring strong clinical knowledge, excellent communication skills, and the ability to work independently while collaborating across multidisciplinary teams. This position supports the Central U.S. region (CO, IL, KS, MO, IA, MN, NE, ND, SD, WY, MT) and requires approximately 50% travel. - Own and execute a regional medical education strategy aligned to the needs of academic institutions and the evolving clinical education landscape. - Partner closely with Sales leadership to ensure awareness of regional education priorities and maintain alignment across teams. - Build and maintain strong relationships with academic stakeholders, including program directors, faculty, residents, and fellows. - Drive early engagement within residency programs (PGY1–PGY2) to support foundational education and long-term relationship building. - Identify gaps in the current education landscape and develop scalable, high-impact solutions (curriculum-based programs, standardized offerings, digital education). - Leverage data and insights to evaluate program effectiveness and inform continuous improvement of educational offerings. - Manage regional education investment with accountability to budget and thoughtful prioritization of resources. - Collaborate cross-functionally with Marketing, Professional Education, and Sales Training to deliver a coordinated and consistent education experience. - Build and manage a network of Key Opinion Leaders (KOLs) and emerging faculty to support content development and program delivery. - Lead strategic planning for priority academic institutions, ensuring consistent engagement and long-term partnership development. - Translate clinical and educational needs into structured education initiatives that support high-quality learning experiences. - Champion innovation in education delivery, including the use of digital platforms and scalable program models. Qualifications - Bachelor’s degree required. - 4+ years of work experience required. - MBA preferred. - 2+ years medical device or Medical Education experience preferred. - Demonstrated proficiency in Microsoft Office (Excel, Word & PowerPoint) preferred. Requirements - Medium work: Exerting up to 50 pounds of force occasionally and/or up to 20 pounds of force constantly to move objects. - Coordination of eye, hand and foot movement with an ability to grasp by hand and meet cognitive demands to include visual and auditory discrimination/memory, reading ability and memory retention ability. Benefits - USN: $77,700 - $129,500 USD Annual - Puerto Rico: $77,700 - $129,500 USD Annual - US5: $81,600 - $136,000 USD Annual - US10: $85,500 - $142,500 USD Annual - US15: $89,400 - $148,900 USD Annual - US20: $93,200 - $155,400 USD Annual - US30: $101,000 - $168,400 USD Annual Company Description Stryker Corporation is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, ethnicity, color, religion, sex, gender identity, sexual orientation, national origin, disability, or protected veteran status. Stryker is an EO employer – M/F/Veteran/Disability. Stryker Corporation will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant.
Our Vision: To lead the nation in caring, healing, teaching and discovering. Join us.
Role Description The Clinical Documentation Integrity Specialist - Inpatient (CDS) will review inpatient medical records as directed on admission and throughout hospitalization for completeness and accuracy for severity of illness (SOI) and risk of mortality (ROM). The CDS will ensure effective and appropriate communication with the attending physicians, residents, fellows, PAs and APNs either verbally or in written methodology to suggest additional and/or more specific documentation. The CDS works closely with the HIM coding staff to assure documentation of discharge diagnosis(es) and any co-existing co-morbidities are a complete reflection of the patient's clinical status and care. - Responsible for concurrent review of the clinical documentation in the medical records and query of the medical staff and other care givers as necessary via prompters/verbal communication to obtain accurate and complete documentation which appropriately supports the severity of patient illness and risk of mortality. - In collaboration with the physician, nurse, patient care coordinator, ancillary departments, and HIM coder, identifies and records principle diagnoses, secondary diagnoses, and procedures. - Conducts initial concurrent review and ongoing re-review for all selected admissions to initiate the tracking process, document findings on the CDS worksheets, and identify other key pathway or quality indicators as appropriate. - Utilizes clinical knowledge to identify need to clarify documentation in records, and utilizes strong communication skills with physician, physician extender, case manager, utilization review, nurse or other healthcare professionals, utilizing appropriate tools to capture needed documentation. - Works collaboratively with the healthcare team to facilitate documentation within the medical record that supports the accurate patient’s severity of illness and risk of mortality. - Utilizes monitoring tools to track the progress of the program, through interpretation of on-site reports, monitoring reports and data. - Shares findings with identified staff. Identifies areas that need focused review through report analysis. - Serves as a resource to physicians and administration regarding issues related to the appropriateness of inpatient DRG assignment. - Reviews coder feedback on completed worksheets and individual CDS tracking system reports as a means of continuous self-evaluation; discusses any issues or concerns with the CDI Supervisor. - Educates Physicians and Staff regarding severity of illness and risk of mortality documentation. - Collaborates with Physicians, Mid-level Providers, CDI Staff, and HIM Coders as well as works directly with individuals and departments where documentation improvement opportunities exist. - Coordinates data and documentation compliance and collaborates on all aspects of the program to improve clinical documentation. - Serves as an effective communicator of the clinical documentation improvement program’s vision and goals. - Expresses ideas clearly and effectively (gaining agreement and/or understanding), by adjusting language, terminology, and style to the characteristics and needs of the audience as well as the venue for the communication. Effectively administers training sessions to new House Staff, Attending Staff, Nursing and Ancillary personnel. - Develops and participates in presentations on clinical documentation improvement. - Demonstrates competence in the areas of critical thinking, interpersonal relationships and technical skills. - Manages his/her organizational responsibilities in a way that supports the achievement of departmental goals. - Works effectively with others in the management team to accomplish organizational goals and to identify and resolve problems. - Skillfully administers, directs and allocates all organization resources. - Uses appropriate interpersonal styles and methods to develop a unit/team-wide spirit and intra-team and inter-team cooperation. - Ensures confidentiality of all data and security of Protected Health Information as it relates to HIPAA requirements. - Must be able to perform the professional, clinical and or technical competencies of the assigned unit or department. Qualifications - Associates Degree in Health Information Management, or a related field of study from an accredited college or university. - Certification in RHIT or RHIA along with CCDS or CDIP. - Nurses only must have an associate degree and 3 or more years of experience in an acute care setting. - All other clinical disciplines must have an associate degree in their respective fields of study from an accredited college or university. - Will also accept foreign medical graduate (MD) along with CDI certification of CCDS and/or CDIP in lieu of Kansas RN license. - 3 or more years of experience in one of the following areas: Clinical Documentation, Case Management/Utilization Review, or Critical Care. Requirements - Licensed Registered Nurse (LRN) - Single State - State Board of Nursing. - Licensed Registered Nurse (LRN) - Multi-State - State Board of Nursing. - Licensed in clinical field of study. - RHIT or RHIA along with CCDS or CDIP. - Foreign medical graduates (MD) with CDI certification of CCDS and/or CDIP in lieu of Kansas RN license. Company Description The health system is an equal employment opportunity employer. Qualified applicants are considered for employment without regard to race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, ancestry, age, disability, veteran status, genetic information, or any other legally-protected status. The health system provides reasonable accommodations to qualified individuals with disabilities. If you need to request reasonable accommodations for your disability as you navigate the recruitment process, please let our recruiters know by requesting an Accommodation Request form using this link asktalentacquisition@kumc.edu. Employment with the health system is contingent upon, among other things, agreeing to the health-system-dispute-resolution-program.pdf and signing the agreement to the DRP.
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• Assist with patient charting, SOAP note creation, H&P documentation, and medical record review • Support the provider by gathering patient information from multiple systems • Review prior patient documentation, organizing clinical information • Prepare comprehensive patient notes for provider review • Access PointClickCare and other EHR systems to gather clinical data • Draft assessment and plan sections based on provider documentation • Maintain organized patient records and documentation workflows • Support provider review workflows by preparing notes in advance whenever possible
The Medical University of South Carolina is an Equal Opportunity Employer. MUSC does not discriminate on the basis of race, color, religion or belief, age, sex, national origin, gender identity, sexual orientation, disability, protected veteran status, family or parental status, or any other status protected by state laws and/or federal regulations. All qualified applicants are encouraged to apply and will receive consideration for employment based upon applicable qualifications, merit and business need. Medical University of South Carolina participates in the federal E-Verify program to confirm the identity and employment authorization of all newly hired employees.
Role Description The RN (Registered Nurse) – Clinical Documentation Specialist I report to their respective Manager, Clinical Documentation. Under general supervision, the RN – Clinical Documentation Specialist I conduct reviews of inpatient electronic medical records to: - Identify missing, vague, and/or incomplete diagnoses. - Collaborate with and facilitate appropriate provider documentation to accurately reflect appropriate DRG (Diagnosis Related Group) assignment. - Assess patient severity of illness and risk of mortality. - Risk adjust for expected mortality/length of stay and clinically validate key diagnoses. The RN – Clinical Documentation Specialist I is responsible for: - A baseline understanding of interpreting quality metrics. - Participation in appropriate ICCE meetings, QAPIs, and/or other identified educational opportunities across the system. Qualifications - Bachelor's degree in nursing from an accredited school of nursing required. - At least five years' clinical nursing experience preferred. - Strong clinical experience and critical thinking skills required. - Extensive knowledge of patient care and clinical measurement tools. - Ability to establish cooperative working relationships with diverse groups and individuals, medical staff, and other health care disciplines. - Licensure as a registered nurse by the South Carolina Board of Nursing or compact state. Requirements - Mobility & Posture: - Standing: Continuous - Sitting: Continuous - Walking: Continuous - Climbing stairs: Infrequent - Working indoors: Continuous - Working outdoors (temperature extremes): Infrequent - Working from elevated areas: Frequent - Working in confined/cramped spaces: Frequent - Kneeling: Infrequent - Bending at the waist: Continuous - Twisting at the waist: Frequent - Squatting: Frequent - Manual Dexterity & Strength: - Pinching operations: Frequent - Gross motor use (fingers/hands): Continuous - Firm grasping (fingers/hands): Continuous - Fine manipulation (fingers/hands): Continuous - Reaching overhead: Frequent - Reaching in all directions: Continuous - Repetitive motion (hands/wrists/elbows/shoulders): Continuous - Full use of both legs: Continuous - Balance & coordination (lower extremities): Frequent - Lifting & Force Requirements: - Lift/carry 50 lbs. unassisted: Infrequent - Lift/lower 50 lbs. from floor to 36”: Infrequent - Lift up to 25 lbs. overhead: Infrequent - Exert up to 50 lbs. of force: Frequent - Vision & Sensory: - Maintain corrected vision 20/40 (one or both eyes): Continuous - Recognize objects (near/far): Continuous - Color discrimination: Continuous - Depth perception: Continuous - Peripheral vision: Continuous - Hearing acuity (with correction): Continuous - Tactile sensory function: Continuous - Gross motor with fine motor coordination: Continuous - Selected Positions: Olfactory (smell) function: Continuous - Respirator use qualification: Continuous - Work Environment & Conditions: - Effective stress management: Continuous - Rotating shifts: Frequent - Overtime as required: Frequent - Latex-safe environment: Continuous Benefits - If you like working with energetic enthusiastic individuals, you will enjoy your career with us! Company Description The Medical University of South Carolina is an Equal Opportunity Employer. MUSC does not discriminate on the basis of race, color, religion or belief, age, sex, national origin, gender identity, sexual orientation, disability, protected veteran status, family or parental status, or any other status protected by state laws and/or federal regulations. All qualified applicants are encouraged to apply and will receive consideration for employment based upon applicable qualifications, merit and business need. Medical University of South Carolina participates in the federal E-Verify program to confirm the identity and employment authorization of all newly hired employees.
We are one of the largest not-for-profit, faith-based health care systems in the nation.
Role Description The licensed Registered Nurse (RN) plans & provides professional nursing services & standards of practice in accordance with level of experience & education, state board of nursing & established policies & procedures. The RN integrates the art, science, leadership & knowledge of the nursing clinical practice through relationship-centered, compassionate, ethical & respectful direct / indirect healthcare services. Essential Functions - Knows, understands, incorporates & demonstrates our Trinity Health Mission, Values, Vision, Actions & Promise in behaviors, practices & decisions. - Acts independently & appropriately within license, scope of knowledge & experience in practice area. - Continues to evolve with best evidence discoveries. - Provides leadership & retains accountability for delegation, choices, decisions & outcomes. - Collaborates with key stakeholders & contributes to quality & improvement practices & outcomes. - Exhibits willingness to take on new & additional responsibilities. - Embraces new ideas & cultural differences while managing competing priorities. Professional Nursing Process (ANA) - Knows, understands, incorporates & demonstrates standard elements of professional practice: Assess, Diagnose, Outcomes Identification / Solutions, Plan, Implement, Evaluate. Professional Development - Participates in own professional development by maintaining required competencies, licenses & certifications. - Identifies learning needs & seeks appropriate assistance or educational offerings. - Supports the learning & development of others (e.g., staff, formal learners, patients, families, community). Compassion, Communication & Stewardship - Incorporates caring process (Caritas), advocacy & appropriate resource utilization as an essential component of nursing practice. - Engages in concrete acts, interpersonal relationships & effective & respectful written, verbal & nonverbal communications. Environment of Care - Practices in an environmentally safe, professional manner. - Monitors & initiates corrections or evidence-based practices, including those for equipment & material resources. - Promotes optimum physical & psychological behaviors. - Influences effective, judicious & financially responsible use of resources. Maintains a Working Knowledge - Of applicable federal, state & local laws/regulations, Trinity Health Integrity & Compliance Program & Code of Conduct. - Ensures adherence in a manner that reflects honest, ethical & professional behavior & safe work practices. Functional Role - RN III – senior: Practice is guided by nursing process & policy / procedure / standards. - Maintains focused area of expertise for care / program & / or provides interventions or knowledge within niche areas of care / program. - Advances professional / shared governance, collaborates inter & intra-professionally. - Delegates to others to advance care, assumes an expanded role & increased responsibility. - Able to lead a small team. - Serves as a unit / service / program nursing practice mentor & identifies learning needs of others. Qualifications - Graduation from an accredited school of nursing. - Valid RN licensure authorized in the applicable state(s) of practice / employment. - Valid driver’s license where required by assignment. Additional Qualifications - Baccalaureate of Science in Nursing (BSN) degree from an accredited school of nursing. - Specialty credentialing & educational degree according to clinical nursing practice specialty area. Pay Range $47.23- $70.84/HR Our Commitment Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.
The University of Arkansas for Medical Sciences (UAMS) has a unique combination of education, research, and clinical programs that encourages and supports teamwork and diversity. We champion being a collaborative health care organization, focused on improving patient care and the lives of Arkansans.
Role Description The Clinical Documentation Improvement Specialist is responsible for improving overall quality and completeness of clinical documentation to ensure that the information in the medical record accurately reflects the patient's severity of illness, clinical needs, and utilization of resources. - This position is responsible for reviewing death medical records to ensure the severity of illness and risk of mortality has been captured at the highest level. - This position works with the providers of care to capture the clinical care in a code format for reimbursement and to ensure UAMS has the correct case mix. - Reviews all admission types to the hospital to ensure severity is captured and then educates the providers of care on admission types. Qualifications - Registered Nurse (RN) with current license plus 4 years inpatient clinical experience in Emergency, Critical Care, or Medical/Surgical area with experience in Quality, Case Management, Clinical Audit, or Data Abstraction OR Coding professional with CCS certification and 6 years of inpatient coding experience with documented education in anatomy/physiology and pharmacology. - CCDS is required within 6 months of hire. - Current CCDS (preferred). Requirements - Applies extensive clinical knowledge to read and analyze health record documentation, identifying all significant diagnoses, treatment, and procedures impacting acuity level and resources consumed throughout the current hospitalization. - Applies knowledge of disease processes, surgical procedures, UHDDS definitions, and the CMS/NCHS ICD-10 Official Coding Guidelines for Coding and Reporting to assign non-indexed terms to the appropriate class within the ICD-10 coding classification system. - Reviews all death medical records and works with Vizient calculator to ensure risk of mortality and severity of illness scores are correct. - Interacts directly with physicians, nursing staff, other patient caregivers, coding staff, and other members of the health care team to facilitate clarification of clinical documentation and transfer of knowledge related to accurate documentation, coding, and reimbursement practices. - Develops and facilitates education related to clinical documentation improvement, coding guidelines, and regulatory requirements to all members of the healthcare team through one-on-one communication and classroom or large group presentations throughout the year as assigned. - Performs other duties as assigned. Benefits - Health: Medical, Dental and Vision plans available for qualifying staff and family. - Holiday, Vacation and Sick Leave. - Education discount for staff and dependents (undergraduate only). - Retirement: Up to 10% matched contribution from UAMS. - Basic Life Insurance up to $50,000. - Career Training and Educational Opportunities. - Merchant Discounts. - Concierge prescription delivery on the main campus when using UAMS pharmacy. Company Description The University of Arkansas for Medical Sciences (UAMS) has a unique combination of education, research, and clinical programs that encourages and supports teamwork and diversity. We champion being a collaborative health care organization, focused on improving patient care and the lives of Arkansans.
The University of Arkansas System is a publicly-aided and comprehensive institution that is made up of several campuses and is the “driving force in the state
• Responsible for improving overall quality and completeness of clinical documentation • Ensure that the information in the medical record accurately reflects the patient's severity of illness, clinical needs, and utilization of resources • Review death medical records to ensure the severity of illness and risk of mortality has been captured at the highest level • Work with the providers of care to capture the clinical care in a code format for reimbursement and to ensure UAMS has the correct case mix • Review all admission types to the hospital to ensure severity is captured and then educate the providers of care on admission types.
Blue Cross and Blue Shield of Kansas City is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, status as a protected veteran, or disability.
Role Description Utilizes a collaborative review process of benefits, minimally necessary clinical information and evidence-based clinical guidelines to formulate decisions regarding medical necessity, pre-existing conditions, benefits and/or individual consideration reimbursement allowables using varied and broad clinical expertise. Acts as a member and provider advocate promoting and coordinating delivery of quality, cost-effective healthcare services based on medical necessity and contractual benefits. The candidate for this position must reside in the Kansas City metropolitan area. - Conducts pre-service, concurrent and/or post-service utilization management reviews to ensure appropriate use of the health care system and to maximize health care dollars. - Schedules time effectively; works with minimal supervision; handles multiple projects simultaneously; prioritizes work appropriately to streamline process and identifies opportunities for quality or process improvement. - Uses critical thinking skills, problem solving and organizational skills; works as a team member while maintaining a positive attitude. - Ensures that reviews and determinations meet requirements with applicable URAC and NCQA guidelines as well as federal and state mandates. - Maintains confidentiality of all PHI in compliance with state and federal laws. - Reads, understands and follows medical policy and all corporate, divisional and departmental policies and procedures. - Reviews provider and/or member submitted medical information to determine pre-existing, medical necessity, benefits & eligibility, and/or reimbursement of a requested service, product or procedure. - Refers cases that do not meet criteria to the Medical Director with an appropriate clinical analysis, summaries and recommendations. - Contributes in the discharge planning of members to appropriate acute, SNF, in-patient hospice or rehab facilities or discharge to home with a safe plan. - Recognizes, documents and reports inappropriate billing patterns or utilization trends of professional and institutional providers to the appropriate business owner. - Communicates effectively with team members, other departments within the organization, management, members &/or providers. - Assesses and educates members &/or providers on a proactive basis; utilizes internal, community and other healthcare resources as well as clinical knowledge to maximize outcomes. - Contributes to reaching or exceeding departmental, divisional and corporate goals. - Knowledgeable of business goals, progress toward accomplishment of goals and works collaboratively with peers to meet or exceed annual departmental targets. - Analyzes qualitative and quantitative data in developing strategies to improve provider performance and member satisfaction. Qualifications - Associate degree in nursing. - 3+ years full-time direct patient care clinical experience in medical/surgical, pediatrics, and/or obstetrics. - Proven experience effectively presenting information and responding to questions from groups of managers, clients, customers, and the general public. - Proven experience in problem definition, data collection to establish facts, and drawing valid conclusions to solve practical problems. - RN license in Missouri and Kansas. Preferred Qualifications - Bachelor’s degree in nursing preferred. - 1+ year(s) of utilization review, disease management, and/or case management experience. - Knowledge of ICD, CPT and HCPCS coding. - Knowledge of URAC and NCQA guidelines and state and federal regulations. - Intermediate keyboarding skills. - Intermediate knowledge of FACETS. - Intermediate knowledge of Clinical Guidelines. Benefits - Highly competitive total rewards package, including comprehensive medical, dental and vision benefits as well as a 401(k) plan that both the employee and employer contribute. - Annual incentive bonus plan based on company achievement of goals. - Time away from work including paid holidays, paid time off and volunteer time off. - Professional development courses, mentorship opportunities, and tuition reimbursement program. - Paid parental leave and adoption leave with adoption financial assistance. - Employee discount program.
Within Health is a SaaS solution that helps health systems and providers communicate and track clinical recommendations and diagnoses to help ensure at-risk pat
Role Description The Senior Utilization Review Specialist (SURS) provides administrative support and management to Within and clients. Additionally, the URS works collaboratively with insurance companies and clinical staff. - Maintain efficient methods for ensuring the medical necessity and appropriateness of prescribed level of care. - Oversee the entire UR process for client journey from admission to discharge. - Complete precertification process and associated documentation. - Audit charts to ensure content reflects medical necessity guidelines. - Ensure continued stay reviews are completed, accurate, and timely. - Assist clinical staff with appeals when necessary. - Provide support to clinical staff around the UR process. - Train new clinical staff on UR process and procedures including documentation of medical necessity. - Provide ongoing training for existing staff on UR and documentation. - Submit initial assessments, continued stay assessments, and payer requested reviews following the established policies and governing regulations. - Communicate with commercial payers per request of payer and Within policy. - Issue complete and concise communications, submitting the critical elements that establish medical necessity. - Follow-up on approval/denial if no reply is received within 12-24 hours by telephone or payer portals. - Document all actions and activities in the case management and billing management systems. - Advise clinical staff on peer review and/or appeals process and provide oversight when necessary. - Communicate with Admissions Specialists and other members of the Clinical team to ensure effective collaboration. - Compile reports and statistics for presentation to the Utilization Review Committee upon request. - Other duties assigned by the supervisor. Qualifications - Experience in a business or health-related field or an equal combination of education and applicable experience within a higher level of care eating disorders setting. - Minimum of 1 year experience performing insurance verification, utilization review or intake assessments in a Residential Treatment Center (RTC), Partial Hospitalization Program (PHP) and/or Intensive Outpatient Program (IOP) environment, eating disorders setting preferred. - Ability to assist in the development and process improvement of obtaining payor authorization and concurrent appeals. - Manages time effectively, setting priorities, and consistently meeting deadlines. - Ability to effectively interact with insurance companies. - Demonstrates initiative and proactive approach to problem resolution. - Can perform well independently and on a team. - Assumes accountability for behaviors consistent with the customer service policy. - Competent in computer based charting, clinical, and non-clinical software programs. - Understands commercial coverage details. - Operates office equipment efficiently. - Demonstrates appropriate judgment and discretion in the UR Coordinator role. Requirements - Must have reliable internet connection. - Must be comfortable operating a computer and smart-phone and navigate applications within macOS and iOS. - Must be comfortable communicating with colleagues via chat, telephone, and video calls. - Must be able to sit for the majority of the shift. - This is a work-from-home position. Work should be performed in a private, quiet space with minimal background noise. Benefits - Competitive compensation package including salary commensurate with experience. - Remote work flexibility with a results-driven culture. - Comprehensive health benefits that reflect our commitment to wellbeing. - The chance to directly transform lives and makes treatment accessible. - Collaborative and innovative work environment with a team passionate about our mission. - Professional development opportunities and support for continued growth.
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