Clinical Adjudication Manager

**Please make sure your application is complete, including your education, employment history, and any other applicable sections. Initial screening is based on the minimum requirements as defined in the job posting, such as education, experience, licenses, and certifications.  Your experience should also address the knowledge, skills and abilities needed for the role. Incomplete applications will not be considered.**

 

*This position is located Remote United States*

 

Position Purpose:

Manages project activities and participates in the development and monitoring of all related tasks. Manages medical and non-medical appeals decisions

 

Essential Responsibilities:

•  Plans and manages project activities to meet contract deliverables.
•  Plans, manages, and develops a standardized approach for dissemination and communication of project information.
•  Plans, manages, and develops presentations or instructional materials related to area of responsibility.
• Plans, prepares, and facilitates regular team meetings.
•  Manages, trains, and evaluates project work activities and personnel.

 

 

Minimum Qualifications

 

Education

• Associate’s degree or 60 or more credit hours towards a Bachelor’s degree from an accredited college or university in healthcare or related discipline
• Additional clinical or medical administration experience may be substituted for Associate’s degree on a year per year basis. (Experience requirements may be satisfied by full-time experience or the prorated part-time equivalent.)

 

Experience

• Five (5) years clinical or medical administration
• Three (3) years management or supervisory

• Healthcare Professional with one (1) year demonstrated experience writing or making medical necessity decisions
• Nursing, Physical Therapy, Respiratory Therapy or Occupational Therapy experience

• Experience directly relevant to Medicare managed care appeals or utilization management activities, preferred

• Resided in the United States for a minimum of three (3) years out of the last five (5) years (Per Contract Requirement)

 

Benefits

C2C offers an excellent benefits package, including:

• Medical, dental, vision, life, accidental death and dismemberment, and short and long-term disability insurance
• Section 125 plan
• 401K
• Competitive salary
• License/credentials reimbursement
• Tuition Reimbursement

 

EOE Vet/Disability