Job Description

Position Status Label: Non- Exempt Labor Category: Medical Remote/Onsite: Remote Additional Informations: Job Summary: The purpose of this position is to utilize clinical expertise to review medical records against appropriate criteria in conjunction with contract requirements to determine medical appropriateness. *Candidates must reside within the State of Oregon or bordering geographies 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 the workload demands of the department
• In collaboration with Supervisor, responsible for quality monitoring activities
• Maintains current knowledge base related to review processes and clinical practices
• Functions as providers' liaison for customer service issues and problem resolution
• Performs all applicable review types as workload indicates
• Fosters positive and professional relationships with internal and external customers
• Attends training and scheduled meetings for current/updated information
• Cross trains to provide flexible workforce to meet client/customer needs
• Read, understand, and adhere to all corporate policies including policies related to HIP nd its Privacy and Security Rules

• Active and unrestricted Registered Nurse (RN) license for Oregon
• Ability to be licensed for the State of Nebraska, if you don't currently hold a compact license
• Bachelor's degree from an accredited college or university in a related field
• 2+ years of experience in Utilization Management or Clinical Review

• Case management experience
• Knowledge of medical records, medical terminology, and disease processes
• Strong clinical assessment and critical thinking skills
• Excellent written and verbal communication skills Hire Talent

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