Clinical Reviewer Job at Hire Talent, Mc Lean, VA

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  • Hire Talent
  • Mc Lean, VA

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
Required Qualifications
  • 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
Preferred Qualifications
  • 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

Job Tags

Contract work, Remote job, Flexible hours,

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