What are the responsibilities and job description for the Clinical Review Specialist - Healthcare Expert position at CarolinaEast Health System?
Job Description
Administrative Role in Utilization Review
About the Position
We are seeking a skilled Clinical Review Specialist to join our team. As a key member of our utilization review department, you will work under the direction of the Utilization Review Manager and Physician Advisor to assist in the administration of utilization review functions.
Your primary responsibilities will include validating medical records, applying clinical knowledge and assessment, and adhering to payer-specific rules and guidelines to determine the appropriateness of inpatient and observation services.
This role requires strong analytical skills, attention to detail, and excellent communication abilities. If you possess a passion for delivering high-quality patient care and have experience in insurance/payer settings, we encourage you to apply.
Key Responsibilities
- Validate medical record documentation
- Apply clinical knowledge and assessment
- Adhere to payer-specific rules and guidelines
- Determine appropriateness of inpatient and observation services
About CarolinaEast Health System
CarolinaEast Health System is committed to providing exceptional patient care across the Coastal Carolina region. Our comprehensive medical center features state-of-the-art technology and a dedicated team of healthcare professionals who strive for excellence in all aspects of patient care.
We offer a robust benefits package to our full-time employees and provide opportunities for growth and development within our organization.
Minimum Requirements
- Graduate from an accredited School of Nursing
- Current RN license with North Carolina State Board of Nursing
- Minimum of five years of clinical experience preferred
- Insurance/payer experience or prior utilization review experience preferred
Benefits
CarolinaEast Health System offers a comprehensive benefits package that includes health, dental, and vision insurance, as well as 401(k) matching and paid time off.
