Massachusetts Licensed Clinical Review Specialist

To support a growing home infusion therapy company, the full-time Massachusetts Licensed Clinical Review Specialist will conduct utilization management reviews and provide clinical information to confirm patient coverage, working remotely with a schedule of Monday to Friday from 8:30 am to 5:00 pm. Key responsibilities: Apply clinical expertise to review therapy checklists and authorization forms, ensuring high-quality, cost-effective care Maintain comprehensive knowledge of regulations, payer contracts, and internal policies to ensure compliance Communicate coverage decisions effectively to members and providers, adhering to established timelines and standards Required qualifications: Medical Assistant certification is required Healthcare experience in a medical setting is required Prior experience in care coordination, home health, or home infusion is preferred Working knowledge of federal/state fraud and abuse laws is required Knowledge of HIPAA Privacy and Security Regulations is preferred