Teams at AllMed Healthcare Management

Performs clinical utilization and quality assurance reviews using evidence-based guidelines to assess medical necessity, care appropriateness, and regulatory compliance. The coordinator documents findings, communicates with providers, ensures timely determination letters, maintains review records, supports complaint resolution, and advises management on compliance concerns. The role requires an unencumbered nursing license, utilization review experience, strong clinical knowledge, HIPAA familiarity, accuracy, confidentiality, and effective communication in a fully remote environment.

Responds to client, physician, and representative inquiries; enters and tracks data; maintains case records; coordinates provider assignments; verifies client information; files reports; supports quality assurance and complaint resolution; and performs clerical duties while complying with HIPAA, regulatory, and company standards.

Coordinates client and provider inquiries, enters and tracks case data, assigns providers, maintains records, monitors report status, supports quality assurance, and performs clerical and customer service duties while following HIPAA, regulatory, and company requirements.