Marketing & Creative
in New York City
, NY
Reference: 19-04159

The Clinical Correspondence Writer/Editor is responsible for generating written medical management determination letters across all of the client’s managed care products as well as reviewing all external communication pieces, ensuring correct grammatical usage, punctuation and syntax.

Duties and Responsibilities:

  • Performs daily reviews of manual letters produced from CCMS to member and providers to ensure adherence to Article 44 and 49 of the NY State Public Health Law and Appendix F, Medicare Managed Care Manual Chapter 13 and commercial contracts and others as necessary
  • Ensures compliance with the client’s corporate branding requirements
  • Conducts quality checks of CCMS event while reviewing letters to ensure compliance to all managed care regulations while identifying and documenting areas of non-compliance
  • Participates in the corporate-wide letter management improvement program and function as one of the department’s participants in writing/editing member and provider letters for the Care Management department
  • Assists with the creation, storage, protection, retrieval and retirement of letters to enrollees, providers and facilities from company systems

Minimum Qualifications:

  • HS diploma or GED

Preferred Qualifications:

  • Bachelor’s degree in related allied health care field such as nursing or social work
  • Basic knowledge MS SharePoint preferred
  • Regularly uses moderately complex oral and written skills. May train others in functional areas and interact with others across the client and/or externally
  • Work experience in healthcare
  • Experience with Medical Management, government programs and managed care, including but not limited to, processing organizational determinations- approvals and denials, or appeals and grievance type of events