Clinical Reviewer job at HireTalent 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 HIPAA and 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

#J-18808-Ljbffr HireTalent

Job Tags

Contract work, Remote work, Flexible hours,

Similar Jobs

Cleveland Research Company

Equity Research Associate- Entry Level Job at Cleveland Research Company

...Job Description Job Description Equity Research Associate Have immediateimpact | Bepassionateabout what you do | Growwith us... ...Requirements: A graduate or an undergraduate business degree Entry level with experiencein a Finance, accounting or Consulting...

Brightter, Inc.

WordPress Developer - Multiple Positions (San Francisco) Job at Brightter, Inc.

...WordPress Developer - Multiple Positions Full-Time Remote Overview We are looking for a skilled WordPress developer to join our remote team. The ideal candidate will have a solid background in WordPress web development and a demonstrated ability to write clean...

CyberCoders

Family Law Attorney Job at CyberCoders

...Job Description Job Description Family Law Attorney Family Law Attorney Position Overview We are seeking an experienced Family Law Attorney to join our legal team. The ideal candidate will be responsible for providing expert legal advice and representation in...

Bartlett & West

Job Survey Technician Job at Bartlett & West

...Assist in production of topographic and boundary surveys. Learn process of organizing field notes. Learn to read construction plans to ensure accurate area to be surveyed. Assist in field staking with stable placement. Perform manual labor, such as cutting brush...

Robert Half

Accounts Payable Lead Job at Robert Half

...Description Job Description We are looking for an experienced Accounts Payable Clerk to join our team in Forest Lake, Pennsylvania. This is... ...to less experienced team members, as needed. This is a REMOTE role but must be located 100 miles from site. Please apply...