BPO Clinical Review Specialist
Compensation
$76k
Employment type
Full-time
Work setting
On-site
Location
Jacksonville, FL
Schedule
Day shift
Posted
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Job overview
The BPO Clinical Review Specialist is a remote full-time position based in Jacksonville, FL. The salary for this role is $76,000 per year, supporting clinical review operations for NTT DATA Services, LLC. This role exists to perform clinical and medical necessity reviews to support the processing of member and provider appeals. The specialist evaluates medical records and clinical documentation to determine medical necessity and prepares recommendations for medical director review.
What you'll do
- Conduct clinical reviews of medical records
- Evaluate medical necessity for appealed services
- Prepare case reviews for Medical Directors
- Recommend approvals or denials
- Ensure compliance with Medicaid and NCQA standards.
What we're looking for
- Skills & competencies
- full-timeremoteclinical reviewjacksonville flhealthcarern$76kappealsutilization managementmedicaid
- Work arrangement
- Weekend coverage required
Benefits & perks
- Medical, dental, vision insurance, 401(k) with match, paid time off, and disability coverage.
Why this role
Requires active Florida RN license.
About the employer
NTT DATA Services, LLC is hiring for this role. Industry: Offices of Physicians (except Mental Health Specialists). Sector: 62.
Additional details
- Industry sector
- 62
- Industry
- Offices of Physicians (except Mental Health Specialists)
- Occupation code
- 29-1141.00
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Listing ID: 1db958c1-43e3-4664-aef5-28a4c16e2121