Job Description

This role is remote, but you must live in Nevada.

Calling all Registered Nurses! Are you tired of long hours on your feet doing bedside care? Are you at a point in your career where you’d rather use your clinical knowledge and skills in an office setting while still helping patients? Then this opportunity is for you! Livanta's Appeals Team in Las Vegas, NV is searching for empathetic, considerate, and responsive individuals to work directly with and assist Physician Reviewers and Medicare beneficiaries. The role of the Review Coordinator is to communicate with and support physician reviewers, summarizing case facts; preparing case questions, and providing assistance to resolve issues requiring physician input. You will also be informing Medicare beneficiaries, healthcare providers, and other partners, of the activities and responsibilities of the Quality Improvement Organization.

Livanta LLC is a Beneficiary and Family Centered Care (BFCC) Quality Improvement Organization (QIO) that serves Medicare beneficiaries in 27 states and US territories. The BFCC-QIO program closely assists Medicare beneficiaries and their families in times of need. At Livanta, you will become a team member that uniquely affects and paves the way for the improvement of Medicare beneficiaries’ lives all over the United States.

Primary Duties:

Performs desktop medical review. Interprets and applies coverage and payment policies, standards of care, and/or utilization review criteria, as applicable to specific position. Communicates with and supports physician reviewers in summarizing facts of cases and issues requiring physician input. Conducts all mandatory case review and quality assurance activities as stipulated by contract(s) and maintains required timeliness and accuracy within the review process. Maintains responsibility for assuring an efficient case review process through the production system, and identifies and corrects problem areas on both a case-by-case and system-wide basis.

Depending on department assigned to, this position may have some or all of the following duties:

Edits text for dissemination in documents handed off to other medical personnel responsible for making phone contact with beneficiaries and providers. Informs beneficiaries and other interested parties of their rights and responsibilities as patients covered by the Medicare program. Acts as a neutral liaison for beneficiaries and/or their representatives. Informs Medicare beneficiaries, healthcare providers, and other partners, of the activities and responsibilities of the Quality Improvement Organization. Staffs the Medicare Beneficiary Helpline during work hours. Collaborates with internal and external QIO staff on development and implementation of healthcare improvement projects.

Essential Knowledge:

Individuals must be detailed oriented and clinically knowledgeable. Knowledge of medical terminology

Essential Education:

Graduation from an accredited school of nursing and current licensure as Registered Nurse (RN). Individuals with a degree in a healthcare related field who possess professional clinical backgrounds with Medicare QIO experience with quality of care reviews or in performing medical reviews in support of MAC or RAC appeals, pre- and post-pay claims reviews, and utilization reviews may also qualify. Minimum of 2-4 years of experience in clinical decision making, relative to Medicare patients.

Essential Skills:

Must have strong computer keyboarding skills and be able to write clearly using the English language. Ability to organize and coordinate multiple simultaneous tasks in a team environment. Ability to exercise sound judgment.

Schedules may vary, and may include weekends & holiday shifts.

Qualified candidates will be contacted and interviews will be conducted quickly – we have open positions now!

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

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