Clinical Account Specialist - Nursing Graduates

Neolytix

20h • Remote

About The Position

Neolytix is seeking individuals with a completed nursing degree who also possess experience in hybrid clinical-operations work. The ideal candidate will be adept at working with queues, productivity targets, multiple systems, and meeting service-level expectations. This role offers the opportunity to utilize clinical training in a structured, queue-driven operations environment.

Requirements

• A completed nursing degree
• Healthcare BPO experience
• Experience working with queues, productivity targets, and multiple systems
• Experience meeting service-level expectations

Nice To Haves

• Hybrid clinical-operations work experience

Responsibilities

• Review clinical documentation and chart notes for completeness, medical necessity, and accuracy in support of authorization, utilization review, or documentation workflows.
• Apply clinical judgment to prior authorization, precertification, or utilization review requests, working within established clinical and payer review criteria.
• Navigate structured, high-volume queues and multiple systems — EHR/EMR, payer portals, and case management or workflow tools — while meeting daily productivity and turnaround expectations.
• Document findings, decisions, and communications completely and accurately, keeping records audit-ready.
• Coordinate with physicians, nurses, and other clinical staff on cases that need additional information or a peer-to-peer review.
• Escalate complex or time-sensitive cases appropriately and track them through to resolution.
• Maintain compliance with HIPAA, payer requirements, and internal quality standards.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level