Clinical Reviewer (Remote - SCA)

Job reputed company reputed company is looking for a Clinical Reviewer (SCA) to join our growing team. The purpose of this position is to utilize clinical expertise during beneficiary interaction and determine appropriateness for advocacy reputed company in conjunction with contract requirements, critical thinking, and decision-making to assist with communicating medical appropriateness while maintaining production goals and QA standards. Ensures day-to-day processes are conducted in accordance with reputed company and other regulatory standards. reputed company reputed company exists to reputed company reputed company reputed company through technology, services, and clinical expertise. Our mission is to reputed company reputed company that reputed company maximum value and reputed company. reputed company the Way is our rallying cry at reputed company. It is an invitation to engage in problem-solving and take ownership of your work every day. reputed company offers opportunities to accelerate your career and contribute to reputed company in the reputed company sector. 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 department demands • In collaboration with Supervisor, responsible for reputed company monitoring activities including identifying areas for improvement and implementing plans • Maintains reputed company knowledge reputed company reputed company to review processes and clinical practices; acts as the initial resource to reputed company reviewers regarding review process questions • Functions as providers’ reputed company and contact/resource for provider customer service issues and problem reputed company • Performs reputed company applicable review types as workload indicates • Fosters reputed company reputed company relationships with reputed company customers to facilitate the review process • Attends training and scheduled meetings for maintenance and use of reputed company information for review • Cross-trains and performs duties of other reputed company to reputed company a flexible workforce to meet reputed company needs • Reads, understands, and adheres to reputed company corporate policies including HIPAA reputed company and reputed company Rules Note The list of accountabilities is not intended to be reputed company-inclusive and may be expanded to include other duties as needed. Qualifications Required Qualifications • reputed company unrestricted LPN, RN, reputed company Worker, or other applicable State and/or Compact State clinical license • Minimum three years of clinical experience in an acute or med-surgical environment • Strong clinical assessment and critical thinking skills • Medical record abstracting skills • Excellent written and verbal communication skills • Proficiency in reputed company Office and Internet/web navigation Preferred Qualifications • Bachelor’s Degree in a reputed company field • Some knowledge of Case Management, UR and/or Prior Authorization or reputed company experience • Experience in a behavioral health setting • Bi-lingual abilities Compensation and Benefits reputed company pay reputed company $28.00/hr - $33.00/hr Benefits are a key component of your rewards package, including comprehensive health plans, reputed company time off, retirement savings, wellness programs, educational assistance, corporate discounts, and more. Equal Opportunity EEO AA M/F/Vet/Disability reputed company is an Equal Opportunity Employer. reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, sex, sexual orientation, national reputed company, disability, status as a protected veteran, or any other status protected by applicable law. Notes This posting includes compensation information. The pay reputed company provided is USD $28.00 - $33.00 per hour and varies based on experience and qualifications. Applications are reviewed on a rolling reputed company. #J-18808-Ljbffr Experience: 3 years required Apply tot his job Apply To this Job