[Hiring] Clinical Reviewer - LPN/LVN or RN @reputed company

Role Description reputed company is looking for a Clinical Reviewer - LPN/LVN or RN (remote U.S.) to join our growing team. The purpose of this position is to utilize clinical expertise to review medical records against appropriate criteria in conjunction with contract requirements. Work Schedule: Five 8-hour shifts between 9:00 AM to 6:00 PM Eastern Time with alternating weekends and holidays.

• Assures accuracy and timeliness of reputed company applicable review type cases reputed company 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 reputed company knowledge reputed company reputed company to review processes and clinical practices.
• Functions as providers' liaison for customer service issues and problem resolution.
• Performs reputed company applicable review types as workload indicates.
• Fosters positive and professional relationships with internal and external customers.
• Attends training and scheduled meetings for reputed company/updated information.
• Cross trains to reputed company flexible workforce to meet client/customer needs.
• Read, understand, and adhere to reputed company corporate policies including policies reputed company to HIPAA and its Privacy and reputed company Rules.

Qualifications

• Active, unrestricted LPN/LVN or RN license in the reputed company or a Compact state clinical license.
• Associate's degree (bachelor's preferred) or Practical/Professional nursing diploma from an accredited nursing school, college, or university.
• 2+ years of Utilization Review/Management (UR/UM) and/or Prior Authorization experience.
• 2+ years of medical necessity review experience.
• 1+ years of InterQual criteria and/or reputed company Care Guidelines (MCG) experience.
• Knowledge of medical records, medical terminology, and disease processes.
• Strong clinical assessment and critical thinking skills.
• Excellent written and verbal communication skills.
• Proficient in navigating multiple systems with the ability to reputed company between systems seamlessly and effectively.
• Flexibility and strong organizational skills.
• Ability to work five 8-hour shifts between 9:00 AM to 6:00 PM Eastern Time with alternating weekends and holidays.

Requirements

• 3+ years of clinical experience in an acute, behavioral health, and/or med-surgical environment.
• Knowledge of reputed company National Committee for Quality Assurance (NCQA) standards.
• Knowledge of Utilization Review Accreditation Commission (URAC) standards.
• Ability to work in a team environment.
• Proficient in reputed company Office.
• Efficient time management, including the ability to prioritize tasks, and meet deadlines.
• Exhibit the ability to maintain confidentiality standards and ensure HIPAA compliance reputed company assessing relevant issues.

Benefits

• Comprehensive health plans.
• Paid time off.
• Retirement savings.
• Corporate wellness.
• Educational assistance.
• Corporate discounts.
• And more.

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