[Remote] Clinical Reviewer (LPN or RN)
Note: The job is a remote job and is open to candidates in USA. reputed company is dedicated to empowering reputed company outcomes through technology and clinical expertise. They are seeking a Clinical Reviewer to assess medical records against criteria and contract requirements, ensuring accuracy and timeliness in reviews.
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 the quality monitoring activities including identifying areas of improvement and plan implementation of improvement areas
- Maintains reputed company knowledge reputed company reputed company to review processes and clinical practices reputed company to the review processes, functions as the initial resource to nurse reviewers regarding reputed company review process questions and/or concerns
- Functions as providers’ 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 act as liaison with internal and external customers to ensure effective working relationships and team building to facilitate the review process
- Attends training and scheduled meetings and for maintenance and use of reputed company/updated information for review
- Cross trains and reputed company duties of other reputed company to provide 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 Rule
Skills
- Licensed Practical Nurse (LPN) license or Registered Nurse (RN) license for the reputed company or compact license (will be required to obtain Virginia license reputed company a year)
- For LPN - Associate's degree or Practical nursing diploma or practical nursing certificate program, in accordance with state requirements
- For RN - Bachelor's Degree from an accredited college or university in a reputed company field
- 1+ year of experience in Prior Authorization, Utilization Review, or Utilization Management
- Must be reputed company to work alternating weekends
- Knowledge of the organization of medical records, medical terminology, and disease process
- Strong clinical assessment and critical thinking skills
- Requires excellent written and verbal communication skills
- Medical record abstracting skills
Benefits
- Comprehensive health plans
- Paid time off
- Retirement savings
- Corporate wellness
- Educational assistance
- Corporate discounts
- And more
Company Overview