Medicaid Case Reviewer

Job Summary

A company is looking for a Case Reviewer to perform utilization reviews for Medicaid services.

Key Responsibilities

• Provides review decisions for prospective reviews based on established criteria
• Ensures thorough review within specified timeframes and serves as a liaison among relevant parties
• Documents medical information accurately in the workflow documentation system

Required Qualifications

• Bachelor's degree in health or human services with at least 1 year of relevant experience, or a high school diploma with at least 3 years of relevant experience
• Demonstrated ability to work with confidential information in a deadline-driven environment
• Intermediate PC skills, including navigating electronic health records
• Experience in a community health care environment and with utilization review of medical services preferred
• Satisfactory completion of a medical terminology course preferred