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Nurse Case Manager/Peer Reviewer
- Are you an experienced Case Manager (RN) 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 Peer Reviewer subcontracting team?
If so, you might be our next new subcontracting team member!
Who we need:
The Peer Reviewer will be utilized to provide a clinical decision where a non-physician reviewer (such as a nurse or certified coder) has completed a medical necessity review based upon criteria. The review will consist of the following: quality of health care services provided to members and medical necessity determinations of care that is being requested.
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 youll do:
- Responsible for quality-of-care medical reviews and determinations utilizing electronic medical records and reports for outcomes submission.
- Available to conduct clinical reviews as requested (volumes determined by federal agency request) for individual review on a case-by-case basis, specialty matched
What youll need:
Required Qualifications
- Must be licensed Registered Nurse/Certified Case Manager
- Current state license, non-restricted licensure required.
- Experienced in all clinical settings of case management, ie, Med/Surg, Oncology, OB, Psychiatry, Orthopedics.
Knowledge, Skills, Abilities
- Understanding of a medical review process; Kepro will provide training and requirements for case review process and reports.
- Basic proficiency in working with web-based care management platforms and Microsoft Office.
Experience
- A minimum of five (5) years active practice experience, providing direct clinical care to patients, as recent as within the past three (3) years.
- Previous experience in clinical peer review is preferred.
Thank You!
We know your time is valuable and we thank you in advance for applying for this position. 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 a Kepro subcontractor 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 as requested with internal and external customers; occasionally lift and/or move objects weighing up to 10 pounds.
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.
Keystone Peer Review Organization, Inc.
