Medical Review Coordinator

Job Description

• Provides administrative and departmental support for Medical Directors (MD).
• Provides oversight on MDworkflow, clinical reviews and assists in completing activities related to cross-functional projects.

• Reviews MD workflow queue in medical management system and makes adjustments to workflows as needed.
• Manage turn-around-times for authorizations that require review by a Medical Director.
• Provides support for the adverse determination process which includes ensuring notification meets regulatory/contractual requirements for content and timeliness.
• Acts as subject matter expert in regards to required departmental best practices, reports and data extracts.
• Conducts research, including reviewing member records, and organizes documentation to report findings in support of Medical Directors.
• Responds to phones as assigned or team coverage as directed by Medical Directors.
• Serves as a liaison in corresponding and communicating with providers, vendors and WellCare contacts and/or members’ representatives.
• Organizes a variety of administrative and clinical tasks and prioritizes in order of importance and impact on members and providers.
• Manage all communications that are utilized between clinical staff, Medical Director and providers.
• Performs other duties and special projects as assigned.

Qualifications

• High School Diploma or GED (required).
• Associate's Degree in a related field (preferred).

• 3+ years of experience in a managed care setting, medical office or facility setting with demonstration of medical administration duties
• 1+ year of experience in directly supporting clinicians, Licenses and Certifications.

Additional Information

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. 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 other characteristic protected by applicable law.