Remote Lead Quality Clinical Reviewer

Job is Expired

Location: Nationwide

Compensation: To Be Discussed

Staff Reviewed: Fri, Jul 02, 2021

Job Category: Quality Assurance

Remote Level: 100% Remote

Weekly Hours: Full Time

Employer Type: Employer

Career Level: Experienced

Education Level: Doctorate

Job Summary

A company that provides critical health and human services programs to state, federal, and local governments is filling a position for a Remote Lead Quality Clinical Reviewer.

Individual must be able to fulfill the following responsibilities:

  • Perform pre-admission and concurrent reviews for admissions and continued placement in Medicaid certified nursing facilities, utilizing federal and State’s criteria
  • Review and communicate all information with providers, utilizing computer database system for determining nursing facility placement appropriateness
  • Utilize both referral screens and medical records review to make determinations

Qualifications Include:

  • Graduation from an accredited school of nursing, with current RN or LPN, or a MSW, or related license, in good standing, as dictated by the client contract
  • At least five (5) years of experience working with individuals with a mental health diagnosis and/or intellectual disability, with the primary focus on behavioral health, as dictated by the client contract, plus two (2) years of quality review experience
  • Minimum of two (2) years of medical experience with a strong understanding of rehabilitation potential, based on diagnosis, age, disease process and chronicity also as dictated by the client contract
  • Experience or observed potential to supervise others in performing up to Reviewer 3 duties
  • Ability to collect data, define problems, establish facts, and draw valid conclusions for supporting a superior written rationale for review determination
  • Ability to develop and document a clinical rationale supporting the review decision as the final step in the review process

COMPLETE JOB DESCRIPTION

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