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Clinical Reviewer at Independent Health - ApplyBlast

Clinical Reviewer

Independent Health

3 months ago

3.1 on Glassdoor

Onsite

Full Time

Senior

0 applicants

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About this role

The Clinical Reviewer is responsible for collecting and reviewing medical records related to quality complaints, grievances, and appeals to support a high‑performing health plan and physician network. The role involves investigating issues, preparing written responses, coordinating with internal stakeholders and medical directors, and providing education to members and providers while ensuring compliance with regulatory standards.

Responsibilities

Investigate clinical appeals and quality complaints
Prepare written responses and plans of correction
Coordinate coverage determinations with internal and external stakeholders
Maintain and monitor case logs and workload prioritization
Identify trends and recommend process improvements

Skills

Qualifications

Registered Nurse (RN) with NYS licenseBSNCertified Coding Specialist (CCS)Certified Professional Coder (CPC)

About Independent Health

independenthealth.com

Headquarters

Buffalo, New York, United States

Company Size

1001-5000 employees

Founded

1980

View Profile

Independent Health has been dedicated to improving the health and well-being of Western New York for over 45 years. They offer Individual and Family plans, Medicare Advantage plans, and NY State sponsored plans including Medicaid, Child Health Plus, and the Essential Plan. Independent Health is known for its exceptional customer service through the RedShirt® Treatment and works alongside the Independent Health Foundation to support community health through awareness, prevention, and education programs.