Title: Case Reviewer

Department: Regional Operating Companies

Reports to: Senior Reviewer & Operations Manager

Job Summary

The primary function of a Case Reviewer is to review and analyze medical records for pre-authorization and IRO determinations. After analyzing provided medical records, case reviewers must create a professional report that includes a summary, appropriate criteria/guidelines, and a conclusion statement. Case reviewers are responsible for amending their reports with any additional information provided. Case reviewers are required to maintain an average daily case load of 25-30 cases per day.

Essential Job Functions

1.      Interpret and apply appropriate guidelines to pre-authorizations, IRO requests, disability requests, etc.

2.      Dictate all report information to be transcribed by our transcription department

3.      Create a high-quality, professional report free from grammar or spelling errors

4.      Perform a low to moderate amount of research on a case by case basis

5.      Reach and maintain a 25-30 average case load per day

Minimum Requirements

1.      LVN, RN, or Physician’s Assistant with current licensure

2.      Demonstrate ability to type at least 45 wpm (as proven by a typing test)

3.      Familiarity with Microsoft Office 2003 (or more recent)

4.      Ability to dictate reports is a plus; maintain an active license during employment

5.      Support others in a team environment

6.      Observe and respect the organizational flow of the office

7.      Sign and abide by the confidentiality agreement and Employee Handbook