Review Coordinator

National Medical Reviews•Warminster Township, PA

1d•$65,000 - $70,000•Onsite

About The Position

The Review Coordinator is responsible for managing case review activities, ensuring adherence to corporate policies and client-specific procedures. This role involves determining review types, selecting appropriate clinical reviewers, and overseeing the entire review process from initiation to final determination. The coordinator acts as a key liaison between clients, peer clinical reviewers, and internal stakeholders, including the Chief Medical Director. Additionally, the position contributes to reviewer recruitment, training, and quality improvement initiatives.

Requirements

Holds a post-secondary degree
Has undergone formal training in a health care field
Experience in health insurance, utilization review, quality management and/or managed care
Pursues excellence while achieving results within defined parameters
Listens effectively and expresses ideas, both verbally and non-verbally, to achieve understanding
Demonstrates flexibility and effectiveness with changing tasks, responsibilities and people
Maintains stable and effective performance under pressure or demanding challenges

Responsibilities

Coordinates case review activities consistent with corporate policy and client-specific procedures
Determines the types of review, peer clinical reviewer specialties and selects peer clinical reviewers
Oversees the logging of cases
Verifies peer clinical reviewer credentials and lack of conflict of interest
Corresponds with reviewers regarding availability, expertise, deadline, etc.
Negotiates and assigns peer clinical reviewer fees (as authorized by the Vice President)
Ensures that the invitation in URPP is forwarded to, and received by, the peer clinical reviewer in a timely manner
Maintains active dialogs with the client and the peer clinical reviewer while the case is under review
Monitors case due date and takes steps to ensure timely return to the client
Ensures that the peer clinical reviewer’s determination is complete and oversees transcription
Notifies the client and other designated parties of the final determination
Interacts on a daily basis with the Chief Medical Director, as needed, to complete case reviews
Serves as the primary liaison and resource for clients and peer clinical reviewers
Assists in the recruitment of new peer clinical reviewers
Participates in staff and/or client meetings and telephone conferences, as needed
Actively participates in the orientation and training of new Review Coordinator Assistants
Participates in quality improvement activities, as requested