This site uses cookies. To find out more, see our Cookies Policy

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

Date Posted: 5/24/2018

Job Snapshot

Job Description

Since 1985, KEPRO has helped more than 20 million members lead healthier lives through clinical expertise, integrity and compassion. KEPRO was founded by physicians and clinical expertise is at the core of our organization. We are a leading quality improvement and care management organization. We offer innovative and outcomes-focused solutions to reduce the unnecessary use of health care resources and optimize the quality of care for public and commercial clients. KEPRO’s tailored programs maximize members’ quality of life, and realize greater cost savings for members and clients alike. KEPRO is on a journey to transform medical management and to develop customized solutions tailored to our client’s specific business requirements, while improving the quality of life for patients, reducing costs, and achieving return on investments for our clients. Our approach to medical management is holistic and compassionate and is coordinated around a patient’s entire healthcare experience.

Clinical Assessor (SUD Waiver)

This position will provide training and consultation to WV Medicaid providers offering medically necessary services under the 1115 CMS Substance Use Disorder (SUD) Waiver.  The candidate will assist providers in establishing various levels of care for substance use disorders according to national criteria and in compliance with WV Medicaid standards.  In addition, the candidate will assist with behavioral health retrospective reviews, provide trainings and ensure compliance with Contractor requirements.  Travel is required and this is a field based position.

Functions:

  • Provide training and information on substance abuse national criteria utilized by WV Medicaid.
  • Perform on-site provider certifications of adult residential substance use programs.
  • Perform provider retrospective reviews, both on-site and desk audits, for WV Medicaid behavioral health providers.
  • Develop and refine review criteria, guidelines and utilization management resources.
  • Provide recommendations related to clinical policies and review/analyze data.
  • Perform duties within contractual time frames and meet performance metrics.

Qualifications:

  • Master’s Degree from accredited university, and
  • Hold an active and unrestricted WV license as either a:
    • Licensed Graduate (or higher) Social Worker (LGSW, LCSW, LICSW)
    • Licensed Professional Counselor
    • Licensed Psychologist
  • Individuals with one of the above licenses will be given priority if they also hold either an Alcohol & Drug Certification (ADC) or Advanced Alcohol & Drug Certification (AADC).
  • Minimum of 2 years of experience providing substance abuse and/or behavioral health services.
  • Experience with WV Medicaid policies and guidelines is preferred.
  • Demonstrate experience with Microsoft 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

  • 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.

Mental and Physical Requirements        

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations will be made as required by law in an attempt to enable an individual with a disability to perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to sit for prolonged periods of time; key and/or control objects; interact extensively with internal and external customers; occasionally lift and/or move objects weighing up to 10 pounds; and occasionally travel within the state.

Only those candidates identified for an interview will be contacted. No Phone Calls Please.  Visit our website at www.kepro.com for more information on the KEPRO Family of Companies.

EOE AA M/F/Vet/Disability

KEPRO is an E-Verify employer. E-Verify is an internet based system operated by the Department of Homeland Security (DHS) in partnership with the Social Security Administration (SSA) that allows participating employers to electronically verify the employment eligibility of their newly hired employees in the United States.

CHECK OUT OUR SIMILAR JOBS

  1. Therapist Jobs
  2. Social Worker Jobs