Ohio Licensed Medical Reviewer IV - Pueblo Colorado

Company: VirtualVocations
Location: Pueblo, Colorado
Posted On: 01/24/2025

A company is looking for a Medical Reviewer IV - Team Lead Managed Care Project (MCP).



Key Responsibilities

Analyze and conduct medical review investigations and data reviews in accordance with UPIC policies
Develop review criteria based on Medicaid laws, rules, and regulations
Mentor and train new medical reviewers while conducting in-depth claim reviews


Required Qualifications, Training, and Education

Bachelor's Degree with active state licensure or equivalent related experience
Minimum of 2 years in Medical Review at ZPIC or UPIC level or in a state Medicaid program
No adverse actions pending or taken against any State or Federal licensing board
Strong leadership and teaching skills
Ability to manage sensitive and confidential material More...

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