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

Date Posted: 2/12/2018

Job Snapshot

Job Description


KEPRO

Clinical Assessor


The candidate will perform retrospective reviews of WV Medicaid providers, offeringbehavioral health and substance abuse services, to ensure compliance with Contractrequirements. Provider reviews, both on-site and desk audits, will assessmedical necessity and compliance with WV Medicaid documentation standards.  Travel is required; this is a home officeposition.

FUNCTIONS:

  • Conducts andappropriately documents provider retrospective reviews utilizing established UMGuidelines, WV Medicaid manuals, and other resources.
  • Provide recommendationsrelated to clinical policies and procedures and based on the analysis ofinformation obtained through provider reviews and utilization data analysis.
  • Interface withstaff and contractors regarding provider concerns, development of reviewcriteria and utilization management resources.
  • Perform jobfunctions within established time frames, participates in team quality reviewactivities and meets performance metrics.
  • Provide technicalassistance, consultation and trainings to providers via phone, web-based andon-site. 

QUALIFICATIONS:

  • Active andunrestricted WV licensed Psychologist, Masters level WV licensed Social Worker (LGSW,LCSW, LICSW) or Licensed Professional Counselor (LPC).
  • In addition toabove licensure, AADC or ADC certification is beneficial.
  • Minimum 1-2 yearsexperience in providing behavioral health and substance abuse services;experience with WV Medicaid preferred.
  • Demonstratedexperience with MS Office – specifically Word and Excel
  • Excellent customerservice, written/verbal communications and organizational skills to meetdeliverables
  • Ability toreview/analyze documentations against set standards
  • Ability to adequatelycommunicate findings and recommendations to providers verbally and throughwriting
  • Ability to workindependently to meet timelines and expectations
  • Ability to interactappropriately with providers under stressful and/or changing conditions
  • Must have high-speed(no dial-up) internet at home.
  • Must be willing totravel and have active, unrestricted driver’s license, reliable transportationand active auto insurance.
  • Must have an OSHAcomplaint home workspace committed to confidentiality of PHI.

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