Strategic Case Management Specialist

WHO WE ARE

Medical Review Institute of America (MRIoA) is the market leader for technology-enabled utilization management (UM) and clinical review solutions – touching over 35M lives. For over 36 years, MRIoA has perfected the utilization and clinical review process for payers, PBM’s, and TPA’s. We offer the largest, most extensive review network in the industry. We have over 30 internal Medical Directors, 50+ Nurses, and 500+ Physicians across 150+ specialties with licensure in all 50 states.

WE ARE HIRING

We are looking for a professional, tech-savvy, self-starter who can participate in the growth of our company by preparing critical health and pharmacy insurance claims for our clinical reviewers.

OUR CASE PROCESSING ANALYSTS:

• Use their excellent customer service skills while working directly with Physician reviewers and maintain communication regarding daily administrative review tasks.
• Utilize their healthcare and/or pharmacy experience to work within multiple computer programs to review clinical documentation and criteria policies, and organize and summarize information, to build a case for the Physician Reviewer.
• Deploy their time management skills to ensure seamless transition of all reviews in a time-sensitive manner.
• Also use their medical knowledge and tools provided, to identify appropriate Physician Reviewers for each case to be reviewed, determine availability, and send review assignments.
• Ensure all compliance processes and procedures are adhered to.

REQUIREMENTS:

• Minimum of 1 year of Healthcare Insurance, Healthcare, or Pharmacy experience required, with an understanding of the medical industry, terminology, and standards.
• Strong Customer Service orientation and teamwork ethic are essential.
• High degree of professionalism in written and verbal communications.
• Excellent learning and memory skills are essential.
• Solid Medical Terminology knowledge is required.
• Solid ability to navigate through various computer software programs.
• High School Diploma or equivalent is required.
• Be able to work 8 hours a day, with a shift between the hours of 7:30 am – 8:00 pm. Analysts are scheduled 5 days per week including weekend shifts.
• Physical Requirements: Must be able to sit at a desk, work on a computer for 8 hours a day.

WE OFFER:

• An opportunity to work with healthcare professionals, including doctors, nurses, and pharmacists, in an administrative office setting.
• A team atmosphere with fun events, and chances to win prizes.
• Growth and training opportunities; we promote from within with a Career Pathing plan.
• Generous benefits including great healthcare, vision, dental, insurance, a huge 401k match, vacation and personal time, paid holidays, and a holiday and a profit sharing bonus.
• Fully remote working environment – no need to come to the office.

Diversity Statement:

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.

MRIoA 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.