Job Summary
A healthcare company is seeking a Remote Quality Clinical Reviewer.
Individual must be able to fulfill the following responsibilities:
- Audit and review case manager and provider clinical documentation and telephone interactions
- Conduct reviews of Quality of Care and Critical/Adverse Incidents
- Review provider treatment records against clinical and procedural established standards
Skills and Requirements Include:
- RN or clinical credentials in a behavioral health field
- 2 years of experience conducting utilization management according to medical necessity criteria
- 2 or more years experience post degree in a clinical, psychiatric and/or substance abuse health care setting
- Knowledge and experience in diverse patient care settings including inpatient care
- Knowledge of ICD and DSM IV coding or most current edition
- Knowledge of utilization management procedures, Medicaid benefits, community resources and providers
