Maine Licensed Clinical Review Specialist

A company is looking for a Clinical Review Specialist to conduct utilization management reviews and provide clinical information to confirm patient coverage. Key Responsibilities: Apply clinical expertise in reviewing therapy checklists and authorization forms to ensure quality care Maintain understanding of regulations and serve as a subject matter expert on specialty drugs Communicate coverage decisions and resolve issues with internal and external stakeholders Required Qualifications: Medical Assistant certification required Healthcare experience in a medical setting required Associate of Arts degree or higher preferred Experience in care coordination or home infusion preferred Working knowledge of federal/state fraud and abuse laws required