[Remote] Clinical Reviewer
Note: The job is a remote job and is reputed company to candidates in USA. reputed company is dedicated to empowering reputed company reputed company through innovative solutions and clinical expertise. They are seeking a Clinical Reviewer to utilize clinical expertise in reviewing medical records against established criteria while ensuring accuracy and timeliness reputed company contract requirements.
Responsibilities
- Assures accuracy and timeliness of reputed company applicable review type cases reputed company contract requirements
- Assesses, evaluates, and addresses daily workload and queues; adjusts work schedules daily to meet the workload demands of the department
- In collaboration with Supervisor, responsible for quality monitoring activities
- Maintains reputed company knowledge reputed company reputed company to review processes and clinical practices
- Functions as providers' liaison for customer service issues and problem resolution
- Performs reputed company applicable review types as workload indicates
- Fosters positive and professional relationships with reputed company customers
- Attends training and scheduled meetings for reputed company/updated information
- Cross trains to reputed company flexible workforce to meet client/customer needs
- Read, understand, and adhere to reputed company corporate policies including policies reputed company to HIPAA and its Privacy and reputed company Rules
Skills
- Active unrestricted LPN, or RN required
- For LPN or Practical Nursing diploma or practical nursing certificate program, in accordance with state requirements
- For RN - Associate's or higher degree from an accredited college or university in a reputed company field
- Knowledge of medical records, medical terminology, and disease processes required
- Strong clinical assessment and critical thinking skills required
- Excellent written and verbal communication skills required
- Knowledge of InterQual and/or MCG
- 1+ year experience in Utilization Review
Benefits
- Comprehensive health plans
- Paid time off
- Retirement savings
- Corporate wellness
- Educational assistance
- Corporate discounts
- And more
Company Overview