Clinical Reviewer
Remote
Job Summary:
· The purpose of this position is to utilize clinical expertise to review medical records against appropriate criteria in conjunction with contract requirements.
· Position is Remote HOWEVER Candidates MUST Reside in California and they need a CA LIC as a Social Worker or LMFT.
· Position is 3 months but may be extended.
Responsibilities:
· Assures accuracy and timeliness of all applicable review type cases within contract requirements.
· Assesses, evaluates, and addresses daily workload and queues; adjusts work schedules daily to meet the workload demands of the department.
· In collaboration with Supervisor, responsible for quality monitoring activities.
· Maintains current knowledge base related to review processes and clinical practices.
· Functions as providers'' liaison for customer service issues and problem resolution.
· Performs all applicable review types as workload indicates.
· Fosters positive and professional relationships with internal and external customers.
· Attends training and scheduled meetings for current/updated information.
· Cross trains to provide flexible workforce to meet client/customer needs.
· Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.
· Knowledge of medical records, medical terminology, and disease processes required.
· Strong clinical assessment and critical thinking skills required.
· Excellent written and verbal communication skills required
Never miss an opportunity! Create an alert based on the job you applied for.
