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Clinical Reviewer - (Contractor - UM - SUD)
- Are you an experienced Clinical Reviewer 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!
This is a FULLY REMOTE position, working from home.
Who we need:
- Utilizes clinical expertise for the review of medical records in conjunction with contract requirements, critical thinking, and decision-making skills to determine medical appropriateness of requested residential and partial hospitalization SUD admissions.
- Performs all applicable review types as workload indicates, accurately and timely.
**Contract: This is a PRN Contract 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.
What youll do:
- Perform a second Medical Necessity (MN) review of partial or fully denied PAs for residential or inpatient substance abuse disorder (SUD) treatment for Colorado Medicaid members.
- Review documentation to determine appropriate course of treatment and services based on patient diagnosis and clinical documentation.
- Utilizes proper and judicious use of verbal and written communications, following KEPRO policies, procedures, and guidelines.
- Maintains medical records confidentiality at all times through proper use of computer passwords, maintenance of secured files, adherence to HIPAA polices.
- Foster positive and professional relationships with internal and external customers Attends training and scheduled meetings for maintenance and use of current/updated information for review.
- Maintains current knowledge base related to review processes and clinical practices related to the review processes.
What youll need:
Required Qualifications
- All clinical reviewers shall have completed ASAM training delivered by ASAM.
- Clinical reviewers shall hold one of the following levels of credentials with a specialization in addiction treatment:
- An MD, board certified in Addiction Medicine,
- A Licensed Addictions Counselor (LAC), and
- Another type of Behavioral Health license (LCSW, LPC, or a LMFT) with a certification in addiction treatment (CACII).
Knowledge, Skills, Abilities
- Knowledge of the organization of medical records, medical terminology, and disease process required.
- Strong clinical assessment and critical thinking skills required. Medical record abstracting skills required.
- Excellent verbal/written communication skills required.
- Ability to work both independently and in a team environment.
- Flexibility and strong organizational skills needed.
- Must be proficient in MS Office and internet/web navigation.
Experience
- 4+ years of relevant clinical experience
- Minimum of one year UM/UR and/or Prior Authorization experience.
- Experience with State Medicaid programs strongly preferred.
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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Keystone Peer Review Organization, Inc.
