KEPRO is looking for a Full Time Clinical Reviewer position in Maine with remote working opportunities!
Apply Here! https://apply.workable.com/j/5465ED1D0C/?utm_medium=social_share_link
Who is Kepro?
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. We provide
technology–enabled services for priority populations to help them remain in the community of their choice. We partner
with government and private healthcare payers to maximize healthcare quality, improve accuracy and increase
efficiency.
What is included in a clinical reviewer position?
Utilizes clinical expertise for the review of behavioral health records against appropriate criteria in conjunction
with contract requirements, critical thinking and decision–making skills to determine medical appropriateness,
while maintaining production goals and QA standards.
Accountabilities
• Reviews and interprets patient records and compares against criteria to determine medical necessity
and appropriateness of care; determines if the medical record documentation supports the need for
services.
• Determines approval or initiates a referral to the physician consultant and processes physician
consultant decisions ensuring reason for the denial is described in sufficient detail on correspondence.
• Abstracts review related data/information accurately and timely on appropriate review tool by the
appropriate means. Accurate and timely submission of all administrative and review related
documents to appropriate parties.
• Foster positive and professional relationships and act as liaison with internal and external customers to
ensure effective working relationships and team building in order to facilitate the review process.
• Responsible for attending training and scheduled meetings and for maintenance and use of
current/updated information for review.
Qualifications
• Active LCPC and/or LCSW is required. Full licensure is required.
Knowledge, Skills, Abilities
• Medical record abstracting skills required.
• Strong clinical assessment and critical thinking skills required.
• Excellent verbal and written communication skills required.
• Ability to work in a team environment.
• Flexibility and strong organizational skills needed.
• Must be proficient in Microsoft Office and internet/web navigation
Experience
• Minimum of one year UR and/or Prior Authorization or related experience.
Kepro offers challenging careers, excellent benefits and opportunities for advancement. For consideration,
please submit resume and cover letter with salary requirements. Only those candidates identified for an
interview will be contacted. No Phone Calls Please. Visit our website at www.Kepro.com for more information
on the Kepro Family of Companies.
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.