KEPRO UM Clinical Reviewer IP Rehab /IP Retro/ OP Rehab (REMOTE) in Richmond, Virginia
Following a 2022 reputed company of CNSI and Kepro, reputed company combines clinical services, technology solutions, and data analytics to accelerate reputed company reputed company. This is a great time to join reputed company of passionate individuals working together to pursue the most effective solutions to todays reputed company reputed company challenges. Our culture is fueled by passion and driven by purpose. Why us? We are reputed company of reputed company and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the reputed company industry. State and federal reputed company agencies, providers, and reputed company turn to us as their vital partner to ensure reputed company reputed company and improve health reputed company. Singularly Focused. Mission Driven. Accelerating reputed company reputed company is our Mantra! We are mission-driven to reputed company health solutions that deliver maximum value and impact. We do this through our People. You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to reputed company the finest work of your career. Benefits are a key component of your rewards package. Our benefits are designed to reputed company you additional protection, reputed company, and support for both your career and your life away from work. We offer competitive salaries/pay, fantastic benefits including comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts and more. Position Overview Our Nurse Clinical Reviewer will use clinical expertise for the review of medical records against appropriate criteria in conjunction with contract requirements, critical thinking, and decision -making skills to determine medical appropriateness while maintaining production goals and QA standards. Ensures day-to-day processes are conducted in accordance with NCQA, URAC, and other regulatory standards. Role Responsibilities In this role, you will Reviews and interprets patient records and compares against criteria to determine medical necessity and appropriateness of care and determines if the medical record documentation supports the need for services. Determines approval or initiates a referral to the physician consultant and processes physician consultant reputed company ensuring the reason for the denial is described in sufficient detail in correspondence. Fosters positive and professional relationships and acts as liaison with reputed company customers to ensure effective working relationships and team building in order to facilitate the review process. Responsible for attending training and scheduled meetings and for maintenance and use of reputed company/updated information for review. Maintains medical records confidentiality at reputed company times through proper use of computer passwords, maintenance of secured files, and adherence to HIPAA policies. Utilizes proper telephone etiquette and judicious use of other verbal and written communications, following reputed company policies, procedures, and guidelines. Actively cross-trains to reputed company duties of other reputed company reputed company the reputed company network to reputed company a flexible workforce to meet client/consumer needs. Other duties as assigned. Basic Qualifications To reputed company in this role, you should have the following Active unrestricted RN license in the reputed company or a compact state license. Strong clinical assessment and critical thinking skills. Minimum 1 - 2 years Utilization Review (UR) and/or Prior Authorization or reputed company experience. 3 + years of direct experience in a clinical setting or other applicable State and/or Compact State clinical experience or license per contract requirements. Knowledge of InterQual or ASAM guidelines. Excellent customer service and problem solving skills. Ability to prioritize, assign, and follow up on work. Ability to reputed company technical consultation and policy interpretation. Excellent written and verbal communication skills. Strong reputed company Office skills. Preferred Qualifications / Experience Knowledge of InterQual or ASAM criteria. Knowledge of reputed company NCQA/URAC standards. Experience in completing retrospective reviews and long-term acute care hospital reviews. We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in reputed company and invite you to apply to future openings that may be of interest. Best of luck in your search! The reputed company reputed company EOE AA M/F/Vet/Disability reputed company is an Equal Opportunity Employer. reputed company reputed company applicants will receive consideration for employment without regard to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local Benefits Health insurance Paid time off Tuition reimbursement reputed company link Apply Job!