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Corporate Functions & Operations WellCare - Coding & Records Careers

Medical Review Coordinator Job

Full Job Title: Medical Review Coordinator

Job Number: 1805569

Location: Tampa, FL

Date Posted: 2018-08-07

Provides administrative and departmental support for Medical Directors. Provides oversight on MD workflow, clinical reviews and assists in completing activities related to cross functional projects.

Reports to: Chief Medical Director

Department: Population Health Solutions

Location: Tampa, FL

Level: 07

Essential Functions:

  • Reviews MD workflow queue in medical management system and makes adjustments to workflows as needed.
  • Manage turn-around-times for authorizations that require review by a Medical Director.
  • Provides support for the adverse determination process which includes ensuring notification meets regulatory/contractual requirements for content and timeliness.
  • Acts as subject matter expert in regards to required departmental best practices, reports and data extracts.
  • Conducts research, including reviewing member records, and organizes documentation to report findings in support of Medical Directors.
  • Responds to phones as assigned or team coverage as directed by Medical Directors.
  • Serves as a liaison in corresponding and communicating with providers, vendors and WellCare contacts and/or members’ representatives.
  • Organizes a variety of administrative and clinical tasks and prioritizes in order of importance and impact on members and providers.
  • Manage all communications that are utilized between clinical staff, Medical Director and providers.
  • Performs other duties and special projects as assigned.
Additional Responsibilities:
    Candidate Education:
    • Required A High School or GED
    • Preferred An Associate's Degree in a related field
    Candidate Experience:
    • Required 3 years of experience in a managed care setting, medical office or facility setting with demonstration of medical administration duties
    • Required 1 year of experience in Directly supporting clinicians
    Candidate Skills:
    • Intermediate Knowledge of medical terminology and/or experience with CPT and ICD-9 coding
    • Intermediate Demonstrated interpersonal/verbal communication skills
    • Intermediate Demonstrated written communication skills
    • Intermediate Ability to effectively present information and respond to questions from peers and management
    • Intermediate Ability to multi-task
    • Intermediate Ability to work as part of a team
    Licenses and Certifications:
    A license in one of the following is required:
      Technical Skills:
      • Required Intermediate Microsoft Outlook Proficient in Microsoft Office such as Outlook, Word and Excel
      • Required Intermediate Microsoft Excel
      • Required Intermediate Microsoft Word
      Languages:

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        Last Updated On: 12/9/2015