Job Description
REMOTE (WFH) | FULL-TIME | 9PM-6AM PHT (FIXED SCHEDULE)
Neolytix is specifically looking for people who’ve already done hybrid clinical-operations work and been both things at once: have completed a nursing degree, and who also knows how to work on queues, productivity targets, multiple systems, and service-level expectations.
WHAT YOU WILL DO:
- Review clinical documentation and chart notes for completeness, medical necessity, and accuracy in support of authorization, utilization review, or documentation workflows.
- Apply clinical judgment to prior authorization, precertification, or utilization review requests, working within established clinical and payer review criteria.
- Navigate structured, high-volume queues and multiple systems — EHR/EMR, payer portals, and case management or workflow tools — while meeting daily productivity and turnaround expectations.
- Document findings, decisions, and communications completely and accurately, keeping records audit-ready.
- Coordinate with physicians, nurses, and other clinical staff on cases that need additional information or a peer-to-peer review.
- Escalate complex or time-sensitive cases appropriately and track them through to resolution.
- Maintain compliance with HIPAA, payer requirements, and internal quality standards.
- Required: A completed nursing degree, combined with healthcare BPO experience.
WHY APPLY? This role allows you to do work that actually uses your clinical training! If you’ve done clinical work inside a structured, queue-driven operations environment before, you got what we need!
