Current job opportunities are posted here as they become available.
Department: | Medicare Program Optimization |
Location: | Atlanta, GA |
Clinical Reviewer, Medicare Clinical Quality
Job Summary
Responsible for reviewing & resolving Medicare complaints/appeals and communicating resolution to members or authorized representatives in accordance with the standards and requirements established by the Centers for Medicare and Medicaid (CMS) and internal clinical policy guidelines and leading the MCAG clinical staff as well as work directly with the Quality team on HEDIS measures,
Knowledge/Skills/Abilities
Required Education
Required Experience
Preferred Education/Experience
of the Medicare appeals process (ALJ, QIO, QIC)