Location:
guadalajara (on-site, fte)
compensation:
competitive remuneration (approx. $23,000 mxn/month gross), annual performance-based bonus, and standard industry benefits.
key responsibilities:
* review admissions and service requests (prospective, concurrent, and retrospective) to determine medical necessity and compliance with reimbursement policies.
* collaborate with physicians and healthcare teams to ensure appropriate documentation, case justification, and discharge planning.
* identify and address inappropriate admissions or denials; notify healthcare teams of reimbursement-impacting decisions.
* act as liaison between the physician advisor and attending physicians to support accurate documentation and clinical appeals.
* support denial resolution processes and ensure all communications with payors are properly documented and escalated when needed.
* communicate efficiently with third-party payors, physicians, patients/families, and internal stakeholders.
* participate in utilization and peer review meetings, providing insight on clinical documentation, treatment duration, and justification.
required competencies and skills:
* excellent written and spoken english
* medical doctor or registered nurse
* experience in clinical review, case management, or utilization review of insurance matters is a plus.