Who we are...

Ciox Health merged with Datavant in 2021, creating the nation's largest health data ecosystems, powering secure data connectivity on behalf of thousands of providers, payers, health data analytics companies, patient-facing applications, government agencies, research institutions and life science companies. The combined company is focused on improving patient outcomes and reducing costs by removing impediments to the secure exchange of health data. Ciox, a Datavant company will offer the ability to access, exchange, and connect data among the thousands of organizations in its ecosystem for use cases ranging from better clinical care and value-based payments to health analytics and medical research.

• Responsible for providing timely referral/appeal determination by accurate
• Usage of the Milliman Care Guidelines and or Interqual
• Appropriate letter language to author appeal letter Identification of referrals to the medical director for review
• Appropriate selection of preferred and contracted providers
• Proper identification of eligibility and healthcare plans
• Maintaining compliance in turnaround time requirements as mandated by the TAT Standards of the facility and/or CIOX Health Standards
• Works directly with the provider(s) and health plan Medical Director as needed to facilitate timely authorizations and/or denial reversals
• Maintains and keeps in total confidence, all files, documents and records
• Meets or exceeds production and quality metrics
• Attend all mandatory meetings and trainings All other job-related duties as it relates to job function as delegated by management

• Two (2) years managed care experience in UM/CM/CDI Department preferred
• Knowledge of CMS, State Regulations, URAC and NCQA preferred
• ICD10 and CPT coding a plus
• Experienced computer skills, Word, Excel, Outlook, experience working in a health plan medical management documentation system a plus.

• Preferred Education: BA or BS in Nursing, experience preferred to preform
• Minimum Experience: 3 to 5 years acute care experience
• 2 years Health Plan or Acute Care UR/CM
• Preferred Experience: 5 years acute care or health plan UR/CM with 1 year ICU/ER