West Virginia Chiropractic Clinical Reviewer

West Virginia

Remote position available

Job Description

This position is a key member of the utilization management team, and provides timely chiropractic review of service requests. Routinely interacts with Chiropractors, leadership and management staff, other Chiropractic and Physician reviewers and staff when Chiropractic input is needed.
  • Perform case reviews, both approvals and denials, for Chiropractic requests.
  • Discuss determinations with requesting Chiropractors, when available, within the regulatory timeframe of the request by phone or fax.
  • Provide the clinical rationale for standard and expedited chiropractic appeals. 
  • Provide assistance and act as a resource to Initial Clinical Reviewers as need to discuss cases and problems. 
  • Utilize Clinical Guidelines and parameters to assure consistency in the DC review process to reflect appropriate utilization and compliance with policies/procedures as well as URAC and NCQA elements. Ensure documentation meets all requirements.
  • Participate in on-going training and inter-rate reliability process. 
  • Assist the Chiropractic Director in research activities/questions related to utilization management process, interpretation, guidelines and/or system support. 
  • Review appeal cases and/or attends hearings for discussions of utilization management decisions.     

General Job Information

Title

West Virginia Chiropractic Clinical Reviewer

Grade

28

Job Family

Clinical Services Group

Country

United States of America

FLSA Status

United States of America (Non-Exempt)

Recruiting Start Date

10/23/2019

Date Requisition Created

10/23/2019

Work Experience

Clinical

Education

DC (Required)

License and Certifications - Required

DC - Doctor of Chiropractic, State Licensure - Care Mgmt

License and Certifications - Preferred

Other Job Requirements

Responsibilities

  • 5+ years of full time experience as a practicing Chiropractor.
  • Graduate of a Chiropractic College accredited by the Council on Chiropractic Education and have a current, unrestricted chiropractic license in the assigned state.
  • Must be certified by the National Board of Chiropractic Examiners.
  • Working knowledge of Commission of Insurance, URAC, NCQA, HIPAA, state and federal requirements regarding UM/QM/Credentialing.

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.

“I receive a high level of support from our Senior Management Team to execute on our vision. They are always accessible and approachable, something I’ve found to be very unique to Magellan.”

Haita Makanji VP of Clinical Strategy and Programs at Magellan MRx