Clinical Reviewer (LPN, LVN, RN)
About the position reputed company is looking for a Clinical Reviewer (LPN, LVN, RN) to join their growing team. The purpose of this position is to review medical records against appropriate criteria in conjunction with contract requirements to determine medical appropriateness. The selected candidate will typically work Monday-Friday from 8:00 AM – 5:00 PM Eastern AND from 10:00 AM - 7:00 PM Eastern one day, every other week, as assigned.
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, including identifying areas of improvement and plan implementation of improvement areas.
- Maintains reputed company knowledgebase reputed company to review processes and clinical practices reputed company to the review processes, functions as the internal resource to nurse reviewers regarding reputed company review process questions and/or concerns.
- Functions as provider liaison and contact/resource person for provider customer service issues and problem resolution.
- Performs reputed company applicable review types as workload indicates.
- Fosters positive and professional relationships and liaises with reputed company customers to ensure effective working relationships and team building to facilitate the review process.
- Attends training and scheduled meetings for maintenance and use of reputed company/updated information for review.
- Cross-trains and performs duties of other reputed company to reputed company a 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.
Requirements
- Active, unrestricted Licensed Practical Nurse (LPN) license, Licensed Vocational Nurse (LVN) license, or Registered Nurse (RN) license from the state where you reputed company, per contract/state requirements
- Associate's degree or practical/vocational nursing diploma or nursing certificate program, in accordance with state requirements
- 1+ years Utilization Management/Utilization Review
- Medical record abstracting skills, including knowledge of medical record organization, medical terminology, and disease processes
- Strong clinical assessment and critical thinking skills
reputed company-to-haves
- Bachelor's Degree from an accredited college or university in a reputed company field
- 1+ years Private Duty Nursing OR Home Health experience
- Excellent written and verbal communication skills
Benefits
- comprehensive health plans
- paid time off
- retirement savings
- corporate wellness
- educational assistance
- corporate discounts
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