Clinical Reviewer-Immediate Advocacy/Quality of Care (RN), Remote

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Requirements:

• Active, unrestricted RN license, Social Worker license, or other clinical license valid in applicable state or compact state.
• Bachelor’s degree in a related field from an accredited institution.
• Proficiency in medical terminology, record organization, and understanding of disease processes.
• Strong clinical assessment and critical thinking skills.
• Medical record abstracting skills.
• Excellent written and verbal communication skills.

Responsibilities:

• Ensure the accuracy and timely completion of case reviews in line with contract requirements.
• Assess daily workloads and adjust schedules as needed to meet departmental demands.
• Collaborate with the Supervisor on quality monitoring, identifying areas for improvement, and implementing enhancements.
• Maintain current knowledge of review processes and clinical practices to provide guidance to nurse reviewers.
• Act as a liaison for healthcare providers, addressing customer service issues and facilitating effective communication.
• Conduct various review types based on workload requirements.
• Foster positive and professional relationships with internal and external stakeholders to support the review process.
• Attend training and meetings to stay updated on review protocols.
• Cross-train on other contracts to support workforce flexibility and meet client needs.