As a Health Clinical Services Senior Analyst, you will be a part of the Fair Hearing team which is responsible for Fair hearing administrative and clinical procedures and participation as the representative for the final determination. Part of the Fair Hearing team is to process FH requests accurately and efficiently. In addition, the FH RN represents policy and medical necessity decisions at the FH in courteous and professional manner while maintaining the requirements and expectations of stakeholder.
You will need to review clinical documents, compare to established medical policies and TAC rule. In addition, you will complete nursing notes, and in some cases create and provide evidence packets.
Please note that this role may require you to work onsite occasionally in Austin, TX based on stakeholder direction.
 
Responsibilities:
Manage review clinical FH packets.
Assess validity of MN determinations.
Collaborate with physicians and clinical health professionals.
Utilize and apply medical policies and TAC criteria.
Participate in open forum for Fair Hearing process inclusive of appellant, physicians, lawyers, and stakeholders.