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Medical Review Clinician

Location: Portland, OR
Job Code: 287
# of Openings: 1

Description

MEDICAL REVIEW CLINICIAN

Are you seeking a career growth opportunity with a national leader which is driven by mission to improve the quality and integrity of healthcare?

AllMed Healthcare Management provides medical peer review solutions to leading health insurance carriers, medical management organizations, TPAs, PBMs and hospital groups, nationwide. Our medical review solutions power clinical decision-making processes for hundreds of clients which provide benefits to over 200 million Americans, and through steady growth AllMed is a recognized leader in this dynamic market. 

We are currently seeking experienced Medical Review Clinicians (RN) to join our clinical operations team, working from our beautiful office in downtown Portland, Oregon.

In this role, you will work closely with our physicians and national peer specialist panel to provide written medical chart reviews and determinations, which power pre-authorizations and appeals for cutting edge treatments and procedures in over 80 specialties and sub-specialties of medicine.

POSITION DESCRIPTION

The Medical Review Clinician (MRC) is responsible for drafting and completing medical necessity reviews and physician peer reviews. As a member of our team, you will work in multiple phases of the production process to produce written reviews that meet the latest evidence-based standards. As a member of our lean organization, you will have the opportunity to work to continuously improve the quality and efficiency of our operations, through individual and team projects, participation in Kaizen events and ongoing learning.

This position works at multiple phases of the review process, including:

  • preparation of cases to ensure essential materials have been submitted
  • coordination of documentation sent to reviewers
  • writing clinical summaries and review/edit reviews returned from our peer specialists
  • ensuring the accuracy of determinations, by checking medical facts, and certifying quality and production parameters are met

REQUIRED SKILLS

  • Bachelors of Nursing or degree in equivalent field of study
  • Must have applicable RN certification/license
  • Demonstrated experience in utilization management, case review and/or medical necessity review in a payer or provider setting
  • Experience in a fast-paced, production-oriented setting for at least two years, and possess knowledge of healthcare industry, terminology, and standards
  • Excellent writing and documentation skills and customer service
  • Computer literacy with demonstrated proficiency in Microsoft Office, email, database and contact management software, and browser-based workflow applications
  • Exhibit a high degree of professionalism in written and verbal communications
  • Attention to detail; critical eye to catch mistakes and errors

BENEFITS

AllMed offers generous compensation and our competitive benefits program includes comprehensive medical and dental care, matching 401K, paid time off, flexible spending accounts, disability coverage, and other benefits that help provide financial protection.

 

AllMed provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, AllMed complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. 





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(800) 400-9916
111 SW Fifth Ave., Suite 1400, Portland, OR 97204
AllMed Healthcare Management, Inc. All rights reserved.

AllMed is an independent review organization with a panel of 400 physician peer reviewers who are licensed, board-certified and in active practice, covering more than 80 ABMS specialties and sub-specialties. AllMed offers medical, copy-editing and customer resources that enable clients to improve quality of care and patient safety.