Clinical Reivewer

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Requirements:

• Active unrestricted LPN or RN State and/or Compact State license.
• Knowledge of medical records organization, medical terminology, and disease processes.
• Strong clinical assessment and critical thinking skills.
• Medical record abstracting skills required.
• Excellent written and verbal communication skills.

Responsibilities:

• Assures accuracy and timeliness of all applicable review type cases within contract requirements.
• Assesses, evaluates, and addresses daily workload and queues; adjusts work schedules daily to meet workload demands.
• Collaborates with Supervisor on quality monitoring, identifies improvement areas and implements plans.
• Maintains current knowledge related to review processes and serves as a resource for nurse reviewers.
• Acts as a liaison for providers regarding customer service issues and problem resolution.
• Performs applicable review types as indicated by workload.
• Fosters professional relationships with internal and external customers to facilitate the review process.
• Attends training and meetings to keep updated on review processes.
• Cross trains to perform duties of other contracts to meet client needs.