Clinical Review Cover Letter

In response to your job posting for clinical review, I am including this letter and my resume for your review.

Previously, I was responsible for support to ensure all clinical components are met for CMS, NCQA, URAC, and all other State and Federal entities.

I reviewed the requirements of the job opening and I believe my candidacy is an excellent fit for this position. Some of the key requirements that I have extensive experience with include:

• Understanding of health care cultures including medical and nursing cultures
• Proficiency in Information Systems, databases, and in the use of technology and computer programs including MS Office (Word, Excel, Power Point, Outlook)
• An understanding of the pharmaceutical industry and drug development
• Managed care or utilization review experience preferred
• Critical Care training, case management, problem solving, interpersonal, written and oral communication, critical thinking and computer skills
• Evaluate reports with regard to performance of the data collection, cleaning and review process
• Interact with Study Data Manager/Project Data Manager to take appropriate action within Data Review & Operations
• Ensure appropriate oversight process and measures are available to Global Clinical Teams and Study Teams

I submit this application to express my sincere interest in the clinical review position.

In my previous role, I was responsible for expertise and direction to Utilization Management staff for solving complex clinical and financial patient situations regarding reimbursement issues, discharge planning, utilization review, continuity of care and systems management.

My experience is an excellent fit for the list of requirements in this job:

• Acts as a resource between area of responsibility and stakeholders to ensure more complex technical requirements, needs and solutions are effectively communicated and understood by all parties
• Knowledge of Agile Methodologies and Scrum ceremonies
• Knowledge of healthcare industry, medical records and the content within, healthcare quality and reporting, HEDIS
• CIP IRB Professional (CIP)
• Knowledge of regulatory and enforcement agencies
• Skilled in Microsoft Office Professional applications
• Demonstrated competence working with STAR / HEDIS and risk-adjustment model
• Passion for patient care and dedication to success of team members

In response to your job posting for clinical review, I am including this letter and my resume for your review.

In the previous role, I was responsible for support to all units within CR&R and Claims to ensure all clinical components are met for CMS, NCQA, URAC, DOL, DOI, and all other State and Federal entities.

My experience is an excellent fit for the list of requirements in this job:

• Currently enrolled in an accredited college/university, pursuing an MBA with a focus on Health Administration or Public Health
• Previous experience using Rave database
• Previous Healthcare internship experience
• Understanding of state/federal regulations that impact coding and reimbursement
• Provide high quality in-service and seminar of coding and coding related topics and clinical documentation integrity
• Working knowledge of Hierarchical Condition Category (HCC) coding and reimbursement methodology
• Current knowledge of ICD and CPT coding systems
• Knowledge of computerization and technological advances in health information

I submit this application to express my sincere interest in the clinical review position.

In my previous role, I was responsible for support to all units within CR&R and Claims to ensure Star Ratings are not jeopardized and all clinical components are met for CMS, NCQA, URAC, DOL, DOI, and all other State and Federal entities.

I reviewed the requirements of the job opening and I believe my candidacy is an excellent fit for this position. Some of the key requirements that I have extensive experience with include:

• Familiarity with important areas such as privacy, security and confidentiality impacting sharing of clinical information
• Knowledge of BCBSTX or BCBSIL Medical Management Policies and Procedures.IL - Chicago, TX - Richardson
• Knowledge of BCBSIL Medical Management Policies and Procedures
• Collaborates with supporting teams to ensure successful execution of organizational goals
• Proven track record of working closely with engineering teams in a scrum environment
• Excellent skills in maintaining, collaborating and supporting relationships at all levels across the organization
• Manages and responds to escalation/conflict issues through to resolution
• Participates in the planning/estimating of projects for his/her assigned area(s) of responsibility

I am excited to be applying for the position of clinical review. Please accept this letter and the attached resume as my interest in this position.

In the previous role, I was responsible for guidance and maintain all specialty drug lists (impacting the pharmacy and medical benefits) including utilization management (UM), Specialty/Optional/Medical lists, Exclusive SRx Home Delivery, clinical edits, business and client reporting, URAC compliance, Therapy Management, HealthEview, RxSavings Messenger and other customer decision tools.

My experience is an excellent fit for the list of requirements in this job:

• Strong knowledge base of health care resources, ideally with managed care experience
• Utilizes knowledge of drugs and pharmaceuticals to conduct post service audits to ensure accuracy of billed charges
• In-depth knowledge of drugs and pharmaceuticals to identify incorrectly billed medications, IV fluids and identify use of drugs for non-FDA approved treatments for investigational and off-label uses/administration
• Familiarity with health care documentation and effective oral and written communication skills
• General computer skills (Microsoft Office, Outlook, Internet search)
• Direct practice with an Adult Behavioral Health Level of Care ( ie
• Expert SAS experience and proven skills in the use of SAS within a programming environment to develop and validate deliverables, proven experience in development of advanced MACROs
• Expert experience in contributing to data review plan and statistical analysis plans and/or constructing technical programming specifications