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Clinical Review - Contract Position in Concord, NH at KEPRO

Date Posted: 2/17/2018

Job Snapshot

Job Description

RNClinical Reviewer – Contract Position

Performs determinations to adults with chronicillness or disability and who are either Medicaid recipients or are seekingMedicaid as payment for long term services, in the community using the Medical EligibilityAssessment tool.

    • Evaluateassessment and care management data to determine ongoing eligibility, careneeds, and service options. Assist in making Level of Care determinations aspart of initial, annual, and event-based (if applicable) assessment process.
    • Monitorand evaluate the individualized care plan, service quality and programeligibility.
    • Applyjudgments and perform clinical practice based upon education, experience, andprofessional practice standards.
    • Participatein trainings, meetings, in-services and continuing education opportunities
    • Ensuresaccurate and timely submission of all administrative and related documents toappropriate parties.
    • Monitorsand complies with all Client and KEPRO requirements relative to accuracy andtimeliness. Maintains production goals and QA standards.

Qualifications

  • Activenon-restricted New Hampshire RN license required
  • Preferred:   2 years clinical experienceor experience conducting Level of Care Determinations
  • Travelis required – must have active/clear drivers’ license
  • Demonstrated knowledge andexperience with relevant social service/rehabilitation systems.
  • Knowledge of applicable stateregulations
  • Must be proficient with MSOffice 
  • Excellent communication,organization & team building skills plus a strong focus on customer service& provider relations required. 
  • Ability to maintain a positiveattitude and contribute both as an individual and a team member to achieve thegoals of the department. 
  • Ability to successfully respond tochange and juggle multiple and changing priorities with sometimes conflictingdeadlines

For consideration, please submit resume and coverletter with salary requirements. Only those candidates identified foran interview will be contacted. No Phone Calls Please.  Visitour website at www.KEPRO.com formore information on the KEPRO Family of Companies