Clinical Reviewer job at Hire Talent Mc Lean, VA, US

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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