Physician Review Coordinator - LHB

At Luminare Health, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Join HCSC and be part of a purpose-driven company that will invest in your professional development.

Job SummaryThe Physician Review Coordinator is primarily responsible for initiation and oversight of the Healthcare Management Division’s physician-level review process with Independent Review Organizations. Additionally, when business needs warrant, the individual conducts medical necessity reviews utilizing evidence-based medical criteria.

Required Job Qualifications:

Possess strong time management and organizational skills

Ability to work independently and complete tasks in a timely manner, reprioritizing workload to meet customer and business needs

Willingness to adjust and adapt to meet the business needs in an atmosphere that sometimes requires rapid change

Comfort with telephonic and written communications with all levels of leadership within the organization, providers, IROs and business contacts in an efficient, professional manner

Excellent customer service and interpersonal skills

Comfort with using electronic applications including electronic documentation system and the ability to accurately document electronically while engaging callers or reviewing medical documents

Excellent verbal and written communication skills

Ability to use commonsense understanding to carry out instructions furnished in written, oral or diagram form

Demonstration of excellent critical thinking skills to deal with problems in varying situations and reach reasonable solutions

Active RN License required

Minimum three years of experience in a clinical setting

Proficient in MS Word, Excel and Outlook with the willingness to expand knowledge of the MS Suite of tools

Active MCG UM/CM Certification or obtain MCG UM/CM Certification within 6 months of hire

Preferred Job Qualifications:

Utilization Management, Case Management, or Claims experience with a TPA or insurer highly preferred

Bachelor of Science in Nursing

Must reside in one of the following States:

Illinois

Montana

New Mexico

Oklahoma

Texas

Indiana

Missouri

Wisconsin

Iowa

Kansas

North Carolina

Pennsylvania

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

EEO Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

Pay Transparency Statement:

At Luminare, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for associates.

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

Min to Max Range:$56,700.00 - $106,400.00

Exact compensation may vary based on skills, experience, and location.

R0044197

Remote/Remotely/Tele/Telecommute/From home