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Clinical Reviewer in Bloomington, MN at KEPRO

Date Posted: 1/20/2018

Job Snapshot

Job Description

KEPRO is a rapidly growing national quality improvement and care management organization. We work to ensure that over 1 billion people receive the right care, at the right time, in the right setting. KEPRO is seeking a highly experienced professional 

                                                               RN Clinical Reviewer 

                                                                     (Retrospective Reviews)

Utilizes clinical expertise for the review of medical records against appropriate criteria in conjunction with contract requirements, critical thinking and decision making skills to determine medical appropriateness, while maintaining production goals and QA standards. Ensures day-to-day processes are conducted in accordance with NCQA, URAC and other regulatory standards.

QUALIFICATIONS

  • Active, unrestricted Minnesota RN license
  • Graduation from an accredited Diploma, Associates or Bachelors degree program
  • Minimum two years of clinical experience in an acute or med-surgical environment required.
  • Minimum of one year UR and/or Prior Authorization or related experience preferred.
  • Knowledge of InterQual criteria strongly preferred.
  • Knowledge of current NCQA/URAC standards strongly preferred
  • Medical record abstracting skills required.
  • Knowledge of the organization of medical records, medical terminology, and disease process required.
  • Strong clinical assessment and critical thinking skills required.
  • Excellent verbal and written communication skills required.
  • Ability to work in a team environment.
  • Flexibility and strong organizational skills needed.
  • Demonstrated strong computer skills; must be proficient in Microsoft Office and internet/web navigation

KEPRO offers challenging careers, excellent benefits and opportunities for advancement.  For consideration, please submit resume and cover letter with salary requirements. 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.




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