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RN Reviewer/Clinical Assessor (Remote)

Full Time
  • Full Time
  • Charleston, West Virginia, United States
  • Kepro profile

Website Kepro

RN Reviewer/Clinical Assessor (Remote)

  • Are you an experienced RN Reviewer/Clinical Assessor looking for a new challenge?
  • Do you value care management and quality improvement?
  • Are you motivated, energetic, and excited to become part of the Kepro team?
  • If so, you might be our next new team member!

Who We Need:

The RN Reviewer/Clinical Assessor reviews prior authorization requests for medical services. The reviewer is required to review clinical information, select the appropriate medical necessity review criteria, and determine if medical necessity is met. Clinical justification for approval or failure to meet criteria must be documented.

Note: This is a fully remote position.

Why us?

Kepro is a rapidly growing national quality improvement and care management organization. We work to ensure that over 20 million people receive the right care, at the right time, in the right setting.

People Focused. Mission Driven.

Shape the future of healthcare with us. We are mission driven to improve lives through healthcare quality and clinical expertise.

We do this through our people.

At Kepro, you can do meaningful work that makes a real difference for the lives of individuals across the country. We are an organization that cares deeply about our employees and we provide the training and support to do the best work of your career. Benefits are a key component of your rewards package at Kepro. These benefits are designed to provide you and your family additional protection, security, and support for both your career and your life away from work. They are comprehensive and fit a variety of needs and situations. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts and more.

What you’ll do:

  • Reviews prior authorization requests for medical services required to review clinical information, select the appropriate medical necessity review criteria, and determine if medical necessity is met.
  • Clinical justification for approval or failure to meet criteria must be documented.

The list of accountabilities is not intended to be all-inclusive and may be expanded to include other education- and experience-related duties that management may deem necessary from time to time.

What you’ll need:

Requirements:

  • Must possess an Active, Valid and Unrestricted Registered Nurse (RN) WV license.
  • Bachelor’s degree or advanced certifications is preferred.
  • Must have electricity, plus safe and secure internet access in your home
  • Must have the capability of having your own home office

Knowledge, Skills, Abilities:

  • Must possess knowledge of medical codes., ICD-10, medical terminology, and clinical assessment and decision-making skills.
  • Utilization Management experience preferred in addition to nursing experience.
  • Knowledge of InterQual criteria preferred. Knowledge of WV Medicaid medical programs and policies preferred.
  • Must have excellent communication skills, critical thinking and clinical skills, writing skills and must be able to review clinical information to assess level of care need, medical case management needs and utilize clinical information in determining medical necessity.
  • Candidates must possess good organization and time management skills and must be able to work independently.
  • Must be able to use clinical information to make medical necessity decisions.
  • Must be able to work independently to meet required metrics.

Experience:

  • Must have a minimum of 5 years experience in a (preferred) behavioral health or medical setting.

Thank You!

We know your time is valuable and we thank you in advance for applying for this position. Due to the high volume of applicants we receive, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Kepro and invite you to apply to future openings that may be of interest. Best of luck in your search!

~ The Kepro Talent Acquisition Team

Mental and Physical Requirements

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations will be made as required by law in an attempt to enable an individual with a disability to perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to sit for prolonged periods of time; key and/or control objects; interact extensively with internal and external customers; occasionally lift and/or move objects weighing up to 10 pounds; and occasionally travel within the state.

EOE AA M/F/Vet/Disability

Kepro is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

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To apply for this job please visit apply.workable.com.