Medical Reviewer

MedFlorida Medical Centers has an opening for a Bilingual Referral Utilization Medical Reviewer at corporate who is responsible for evaluating referrals for medical necessity and coordinating specialty care for patients in need of external consultation/testing as requested by the primary care physician or specialists to help in the control of utilization costs. Working on hand with insurance companies and care providers to share essential patient information. Representing the company professionally and positively to enhance and promote the core values and mission of Medical Consultants Management.

The ideal candidate will have medical audit experience and will be comfortable working with insurance companies and care providers to share essential patient information. Other job duties include: Obtaining insurance authorizations, tracking and documenting referrals on EMR systems, and advising providers about authorization denials.

Qualifications:

• EMR system knowledge (eClinicalWorks preferred)
• Answer high calls volume
• Foreign medical graduates encouraged to apply

• Clinical Experience Required

SKILLS: Detailed-oriented and problem-solving abilities.

• Effective verbal and written communication skills
• Teamwork orientation
• Organized and able to manage competing priorities
• Good judgment
• Resourcefulness in problem solving
• Able to take and follow through with delegated tasks and accountability
• Medical Terminology knowledge

Review cases to determine Medical Necessity for treatment/tests

MedFlorida Medical Centers offer a competitive salary, medical, dental, vision and gap benefits, Holiday pay, vacations and PTO.