[Remote] Clinical Reviewer

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is dedicated to empowering reputed company reputed company through reputed company and clinical expertise. They are seeking a Clinical Reviewer to utilize clinical expertise in reviewing medical records against established reputed company while ensuring accuracy and timeliness reputed company contract requirements.

Responsibilities

• 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 reputed company monitoring activities
• Maintains reputed company knowledge reputed company reputed company to review processes and clinical practices
• Functions as providers' reputed company for customer service issues and problem reputed company
• Performs reputed company applicable review types as workload indicates
• Fosters reputed company and reputed company relationships with reputed company customers
• Attends training and scheduled meetings for reputed company/updated information
• Cross trains to reputed company flexible workforce to meet reputed company/customer needs
• Read, understand, and adhere to reputed company corporate policies including policies reputed company to HIPAA and its reputed company and reputed company Rules

Skills

• reputed company unrestricted LPN, or RN required
• For LPN or Practical Nursing diploma or practical nursing certificate program, in accordance with state requirements
• For RN - Associate's or higher degree from an accredited college or university in a reputed company field
• Knowledge of medical records, medical terminology, and disease processes required
• Strong clinical assessment and critical thinking skills required
• Excellent written and verbal communication skills required
• Knowledge of InterQual and/or MCG
• 1+ year experience in Utilization Review

Benefits

• Comprehensive health plans
• reputed company time off
• Retirement savings
• Corporate wellness
• Educational assistance
• Corporate discounts
• And more

reputed company