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Clinical Assessor - Field or Telephonic in Charleston, WV at KEPRO

Date Posted: 4/12/2018

Job Snapshot

Job Description


KEPRO

Clinical Assessor


The candidate will perform retrospective reviews of WV Medicaid providers, offering behavioral health and substance abuse services, to ensure compliance with Contract requirements. Provider reviews, both on-site and desk audits, will assess medical necessity and compliance with WV Medicaid documentation standards.  Travel is required; this is a home office position.

FUNCTIONS:

  • Conducts and appropriately documents provider retrospective reviews utilizing established UM Guidelines, WV Medicaid manuals, and other resources.
  • Provide recommendations related to clinical policies and procedures and based on the analysis of information obtained through provider reviews and utilization data analysis.
  • Interface with staff and contractors regarding provider concerns, development of review criteria and utilization management resources.
  • Perform job functions within established time frames, participates in team quality review activities and meets performance metrics.
  • Provide technical assistance, consultation and trainings to providers via phone, web-based and on-site. 

QUALIFICATIONS:

  • Active and unrestricted WV licensed Psychologist, Masters level WV licensed Social Worker (LGSW, LCSW, LICSW) or Licensed Professional Counselor (LPC).
  • In addition to above licensure, AADC or ADC certification is beneficial.
  • Minimum 1-2 years experience in providing behavioral health and substance abuse services; experience with WV Medicaid preferred.
  • Demonstrated experience with MS Office – specifically Word and Excel
  • Excellent customer service, written/verbal communications and organizational skills to meet deliverables
  • Ability to review/analyze documentations against set standards
  • Ability to adequately communicate findings and recommendations to providers verbally and through writing
  • Ability to work independently to meet timelines and expectations
  • Ability to interact appropriately with providers under stressful and/or changing conditions
  • Must have high-speed (no dial-up) internet at home.
  • Must be willing to travel and have active, unrestricted driver’s license, reliable transportation and active auto insurance.
  • Must have an OSHA complaint home workspace committed to confidentiality of PHI.

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