Job Details

**Please make sure your application is complete, including your education, employment history, and any other applicable sections. Initial screening is based on the minimum requirements as defined in the job posting, such as education, experience, licenses, and certifications. Your experience should also address the knowledge, skills and abilities needed for the role. Incomplete applications will not be considered.**

*This position is located Remote United States*

Position Purpose:

Ensures decision makers adjudicate cases accurately by performing quality audits, reviews, and publishing audit results and conducting meetings, providing coaching, and training on quality.

Essential Responsibilities:

• Oversees, plans, and monitors the quality assurance program.
• Oversees, plans, and audits to ensure timeliness, accuracy, and consistency in reconsideration decisions.
• Oversees, develops, and identifies individual and collective training opportunities based on audit findings and/or data analysis of reconsiderations decisions to help improve individual and corporate quality.
• Oversees, plans, prepares, reviews and analyses data to identify problems, trends and improvement opportunities.
• Oversees, plans, and reviews reopened cases and cases from the problem log in order to identify trends and needs for improvement.

Minimum Qualifications

Education

• Associate's degree or 60 or more credit hours towards a Bachelor's degree from an accredited college or university in healthcare or related discipline
  • Additional Medicare appeals or clinical experience in a healthcare setting may be substituted for Associate's degree on a year per year basis. (Experience requirements may be satisfied by full-time experience or the prorated part-time equivalent.)

Experience

• Five (5) years medical dispute, Medicare appeals or clinical experience in a healthcare setting

• Three (3) years management or supervisory

• Two (2) years of training
• Medicare
• Healthcare Professional (or professional specified within or relevant to contract) with demonstrated experience writing or making medical necessity decisions
• Nursing, Physical Therapy, Respiratory Therapy or Occupational Therapy experience; or relevant experience specified within or relevant to contract
• Resided in the United States for a minimum of three (3) years out of the last five (5) years (Per Contract Requirement)
• Experience directly relevant to Medicare managed care appeals or utilization management activities, preferred

Benefits

C2C offers an excellent benefits package, including:

• Medical, dental, vision, life, accidental death and dismemberment, and short and long-term disability insurance
• Section 125 plan
• 401K
• Competitive salary
• License/credentials reimbursement
• Tuition Reimbursement

EOE Vet/Disability

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.