Medical Reviewer IV – Ohio

Job Summary

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

Key Responsibilities:

• Analyze and conduct medical review investigations in accordance with UPIC policies
• Develop review criteria for claims and provide expert testimony as needed
• Train and mentor new medical reviewers and assist in quality reviews

Required Qualifications:

• Bachelor’s Degree with active state licensure or graduate from an accredited RN school
• 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 by any State or Federal licensing board
• No conflict of interest as defined in the Social Security Act