Clinical Reviewer (Remote)

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Requirements:

• Active unrestricted LPN or RN State and/or Compact State license.
• Knowledge of the organization of medical records, medical terminology, and disease processes.
• Strong clinical assessment and critical thinking skills.
• Medical record abstracting skills.
• 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 activities and implementation of improvement plans.
• Maintains current knowledge related to review processes and acts as a resource for nurse reviewers.
• Acts as a liaison for provider customer service issues and problem resolution.
• Performs all applicable review types based on workload indications.
• Fosters positive relationships with internal and external customers to facilitate the review process.
• Attends training and meetings for updated information.
• Cross-trains to perform duties of other contracts for flexibility.