About the Company - The Part C QIC program is responsible for rendering decisions on 2nd-level Medicare Advantage appeals. We serve as the Independent Review Entity for Medicare Part C, meaning that we work for Medicare. Our main role is to review Medicare Part C appeals to determine if a Medicare Health Plan's denial of an item or service is appropriate. Many of these cases involve issues of Medical Necessity which require a physician's review. This review is then incorporated into a decision letter that is disseminated to all parties to the appeal.
About the Role - Common medical necessity issues are: continued stay in a Skilled Nursing facility; medical appropriateness of drugs, medical appropriateness of diagnostic imaging, etc.
Responsibilities - Minimum Qualifications:
Pay range and compensation package - Qualified Independent Contractor Medicare Part C Standard Case Reviews will have Due Date Specified- $ 65/review 30 mins to complete Expedited Review (Physicians)- $ 90/review 30 mins to complete
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