Referral Coordinator Reviewer

Position Overview   The Referral Coordinator Reviewer is responsible for reviewing medical referrals to determine medical necessity and ensure compliance with CMS (Centers for Medicare & Medicaid Services) guidelines and criteria.

This role involves thorough evaluation of referral documentation, application of clinical guidelines, and collaboration with healthcare providers to facilitate appropriate patient care.

Key Responsibilities Review and assess medical referrals to establish medical necessity based on CMS guidelines and other guidelines.

Apply clinical guidelines and criteria to ensure referrals meet established standards.

Communicate with healthcare providers to obtain additional information or clarification as needed.

Document review findings and decisions accurately in the appropriate systems.

Collaborate with other healthcare team members to ensure coordinated and efficient patient care.

Mainta...