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Clinical Educator in Tampa, FL at KEPRO

Date Posted: 10/30/2018

Job Snapshot

Job Description

Accountabilities

Activities include, but are not limited to:

  • Produce the written Final Review Result correspondence; to include:
    • Individualized hospital results
    • Claim-by-claim denial rationales
    • Clinical details that can be used to foster further discussions and serve as basis for provider educational sessions
  • Facilitate one-on-one provider educational sessions;
  • Maintaining all timelines associated with claim redetermination reviews;
    • Providing monthly summaries/updates for the CMS report;
    • Meeting all contract timeframes for reviews;
    • Maintaining lines of communication (verbal and written) between the BFCC QIO, healthcare providers and/or practitioners,;
      • Providing excellent customer service to all parties
    • Meeting contract evaluation measures
      • Utilization review timeliness: >95% timeliness for CY 2-5
    Willingness to cross-train and perform duties of other contracts within KEPRO to provide a flexible workforce to meet client/customer needs.
Qualifications

§  Education (general level if required) or specific courses

Unrestrictive and active Nursing license as a Registered Nurse (RN); BSN is preferred; along with Certified Professional in Utilization Review (CPUR)

§  Skills, Knowledge

Abilities (SKA)

§  Excellent verbal and written communication skills

§  Proficiency in planning, coordinating and implementing patient and staff safety procedures

§  Good judgment and decision-making abilities

§  Critical thinking and ability to prioritize tasks

§  Strong interpersonal, organizational and customer service skills

§  Ability to effectively meet contract timelines/deadlines

§  Ability to work independently and as part of a team

§  Ability to research/identify and apply appropriate standards of care

§  Interest in continuous learning and a commitment to staying informed on regulatory changes

§  Talent for leading and facilitating group and team meetings

§  Attention to detail and analytical skills

§  Comfort in handling challenging situations that may involve adverse outcomes

§  Ability to maintain a calm, professional demeanor under pressure

§  Ability to manage change, growth, changing priorities

§  Experience (If needed, describe kind & amount)

§  Five years’ clinical experience in either a short-term acute care hospital or skilled nursing facility

§  Five years’ previous experience as a claims or risk manager preferred

§  Previous experience reviewing and investigating patient complaints

§  Previous quality improvement experience

§  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.

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