Utilization Review Analyst (Fully Remote)

Who We Are

Founded in 1983, the Medical Review Institute of America (MRIoA) is the market leader for technology-enabled utilization management and clinical medical review solutions. We have an outstanding reputation for excellence and achieve continual improvement.

At MRIoA, we believe our employees are the key to our success. Here, you are more than just a cog in the machine – you are a valued member of our team.

WE OFFER

• A competitive compensation package.
• Benefits include healthcare, vision and dental insurance, a generous 401k match, paid vacation, personal time, and holidays.
• Growth and training opportunities.
• A team atmosphere with fun events and prizes scheduled throughout the year.
  
  

Position Overview

Staff level position responsible to carry out day-to-day departmental tasks and complete all processes for screening incoming requests, preparing information and materials to route to the next appropriate step in the review process.

Roles:

• To prepare high quality, complete case information and materials for submission to a nurse for utilization review.
• To serve as a company liaison with clients, practitioners/providers/facilities and our staff to resolve questions and concerns
  
  

Major Responsibilities or Assigned Duties:

• Screen incoming requests and analyze for completeness and correctness.
• Follow workflow procedures to provide nurses with cases that are ready to be worked with all necessary information.
• Contact clients/MRIoA staff/providers/facilities as needed to resolve questions, obtain information, records and/or materials needed for case review and to resolve issues about active cases.
• Respond to reviewer requests for additional information/materials necessary for a review and notify clients and other internal departments of these needs, as applicable.
• Monitor queues, spreadsheets, chats or perform other tasks to as requested.
• Collaborate with nursing staff to resolve issues on active cases.
• Support all Quality Management initiatives
• Support all Compliance Program activities
• Provide backup support to staff in other areas as applicable.
• Participate in all company meetings and committees as requested.
• Maintain a flexible schedule to meet client needs.
• Adhere to all policies and procedure
• Take feedback and responsibility for performance
• Adapt to differences of clients
• Generate and send determination correspondence to providers and members
• Finalize cases in the client's system
• Complete other duties and responsibilities as directed.
  
  

Requirements:

Skills and Experience:

• Ability to work under pressure and meet deadlines while managing multiple high priorities
• Personal computer literacy and high competency in use of Microsoft suite products (e.g. Word,
• Outlook, Teams, Excel), use of multiple programs and windows simultaneously, and multiple accounts and passwords
• Strong working knowledge of basic anatomy, physiology and medical terminology
• Strong attention to detail
• Strong organizational skills
• Strong oral and written communication skills
• Well-developed customer service skills
• Ability to work independently with minimal supervision
• Understanding and knowledge of company's clients, products, departments and workflows, and applicable regulatory requirements and accreditation standards
  
  

YOUR BACKGROUND

• Minimum of 1 years’ experience in a similar role
• Bachelor's degree in a related field preferred
  
  

Work Environment:

Ability to sit at a desk, utilize a computer, telephone, and other basic office equipment is required. This role is designed to be a remote position (work-from-home).

Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.



This company is a drug-free workplace. All candidates are required to pass a Background Screen before beginning employment. All newly hired employees will take a Drug Screen, as well as agreeing to all necessary Compliance Regulations on their first day of employment.