Clinical Reviewer, RN, LPN, or LCSW Fully Remote
Posted on: January 16, 2022
Are you an experienced Clinical Reviewer looking for a new
Do you value care management and quality improvement?
Are you motivated, energetic, and excited to become part of the
If so, you might be our next new team member!
This is a fully remote position.
Who We Need
Kepro's Clinical Reviewer utilizes clinical expertise for the
review of medical records against appropriate criteria in
conjunction with contract requirements, critical thinking and
decision-making skills to determine medical appropriateness.
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
People Focused. Mission Driven.
Shape the future of healthcare with us. We are mission driven to
improve lives through healthcare quality and clinical
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
Utilizes clinical expertise for the review of medical records
against appropriate criteria in conjunction with contract
requirements, critical thinking and decision-making skills to
determine medical appropriateness.
Performs all applicable review types as workload indicates,
accurately and timely. These may include:
Audiology, Diagnostic Imaging, DME, inpatient hospital
admissions/concurrent review, PT/OT/ST, Home Health/Private Duty
Nursing, EPSDT; Children's Behavioral Health.
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
Maintains current knowledge base related to review processes and
clinical practices related to the review processes.
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 medical records confidentiality at all times through
proper use of computer passwords, maintenance of secured files,
adherence to HIPAA polices.
Utilizes proper telephone etiquette and judicious use of other
verbal and written communications, following KEPRO policies,
procedures and guidelines.
Other duties as assigned. The list of accountabilities is not
intended to be all-inclusive and may be expanded to include other
duties that management may deem necessary.
What you'll need:
Active unrestricted LPN, RN, Licensed Social Worker or other
applicable State and/or Compact State clinical license per contract
Graduation from an accredited Diploma, Associates or Bachelor's
Knowledge, Skills, Abilities
Knowledge of InterQual or MCG (Milliman) criteria strongly
Knowledge of current NCQA/URAC standards strongly preferred
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 in a team environment.
Flexibility and strong organizational skills needed.
Must be proficient in MS Office and internet/web navigation.
2+ years of relevant clinical experience
Minimum of one year UM/UR and/or Prior Authorization or related
Experience with State Medicaid programs strongly preferred.
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.
Keywords: Kepro, Cleveland , Clinical Reviewer, RN, LPN, or LCSW Fully Remote, Healthcare , Cleveland, Ohio
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