United States onlyDescription
WHO WE ARE
Founded in 1983, the Medical Review Institute of America (MRIoA) is the market leader for technology-enabled utilization management and clinical medical review solutions. We have an outstanding reputation for excellence and achieve continual improvement.
At MRIoA, we believe our employees are the key to our success. Here, you are more than just a cog in the machine – you are a valued member of our team.
WE OFFER
- A competitive compensation package.
- Benefits include healthcare, vision and dental insurance, a generous 401k match, paid vacation, personal time, and holidays.
- Growth and training opportunities.
- A team atmosphere with fun events and prizes scheduled throughout the year.
POSITION OVERVIEW
Staff level position responsible to carry out day-to-day departmental tasks and complete all processes for screening incoming review requests, preparing review information and materials for assignment to appropriate Reviewers and maintaining online case summary/tracking system information
Roles:
- To prepare high quality, complete packets of appropriate case review information and materials for submission to the panel reviewers
- To serve as company liaison with clients, reviewers and practitioners/providers/facilities whose services are subject to review
Major Responsibilities or Assigned Duties:
- Screen incoming review requests for completeness of materials required to conduct the review of the case
- Prepare, organize, distribute and present records, materials and forms required for a complete case review packet for Reviewers
- Identify appropriate Reviewers for case review assignment including (next two bullet points):
- Determine their availability for a review assignment; and
- Obtain information for delivery of the case to the reviewer, if applicable
- Contact clients to resolve questions, obtain information, records and/or materials needed for a case review and resolve issues about active cases
- Respond to reviewers’ requests for additional information/materials necessary for a review and notify clients and other internal departments of these needs, as applicable
- Coordinate and record phone consultations between Reviewers and practitioners/providers/facilities that are party to a review case
- Create and maintain an in-house review file for each active case
- Respond to inquiries from clients, other entities referring cases for review and practitioners/providers/facilities
- Support all Quality Management initiatives
- Actively participate in the Complaint Process and Provider Relations assessment process
- Support all Compliance Program activities
- Provide backup support to staff in other areas as applicable
- Participate in all company meetings and committees as requested
- Maintain a flexible schedule to meet client needs
- Adhere to all policies and procedures
- Take feedback and responsibility for performance
- Adapt to differences of clients
- Complete other duties and responsibilities as directed
Position Levels
Each level attained compounds responsibilities with those of prior levels
- Analyst I-IV & Auditors or exceeds the goals for the respective level (see Career Pathing attachment)
- Meets or exceeds the goals for the respective level (see Career Pathing attachment)
- Training period to last from date of hire to an estimated 6 months*
- Production should increase regularly, with expected career path benchmarks
- Quality should increase regularly, with expected career path benchmarks
- Adherence to all policies and procedures
- Takes feedback and responsibility for performance
- Adapts to the differences of clients
Requirements
Skills and Experience:
- Ability to work under pressure and meet deadlines while managing multiple high priorities
- Personal computer literacy and high competency in use of Microsoft Word, Microsoft Excel and Adobe
- Strong working knowledge of basic anatomy, physiology and medical terminology
- Strong detail orientation
- Strong organizational skills
- Strong oral and written communication skills
- Well-developed customer service and training skills
- Ability to work independently with minimal supervision
- Understanding and knowledge of company's clients, products, departments and workflows, and applicable regulatory requirements and accreditation standards
Experience
- Minimum one year’s experience in similar operations
- Experience in health care, managed care or utilization management company
Education:
- High school diploma
- Preference for Bachelor's degree preferably in business or health care
Work Environment:
Ability to sit at a desk, utilize a computer, telephone, and other basic office equipment is required. This role is designed to be a remote position (work-from-home).
Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
This company is a drug-free workplace. All candidates are required to pass a Background Screen before beginning employment. All newly hired employees will take a Drug Screen, as well as agreeing to all necessary Compliance Regulations on their first day of employment.
