Concurrent Review Lead

About the role

Manage the Concurrent Review Operations. Oversee daily concurrent review activities for inpatient and high-cost cases, ensure all cases are reviewed within SLA and aligned with clinical guidelines, monitor length of stay (LOS) and ongoing treatment appropriateness, and act as escalation point for complex or critical cases.

Key responsibilities

• Oversee daily concurrent review activities for inpatient and high-cost cases
• Ensure all cases are reviewed within SLA and aligned with clinical guidelines
• Monitor length of stay (LOS) and ongoing treatment appropriateness
• Act as escalation point for complex or critical cases
• Ensure consistent application of evidence-based medical guidelines
• Standardize decision-making across reviewers
• Review and validate complex or borderline cases
• Maintain documentation quality and audit readiness
• Engage with hospitals and treating physicians on ongoing cases
• Collaborate with Medical Hotline, Medical Management, Claims, Underwriting, and Provider teams

About you

• Education background related to Medical Degree (Medical Doctor, Medicine, Public Health, Nurse, etc)
• At least 5-7 years working experience in Insurance industry and other clinical experience
• Leadership / supervisory experience
• Strong clinical judgment, analytical thinking, communication, negotiation, attention to detail and ability to make a fast decision