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RN Clinical Reviewer - Psychiatric in Charleston, WV at KEPRO

Date Posted: 7/17/2018

Job Snapshot

Job Description

RN Clinical Reviewer
Conducts consultative retrospective review of medically necessary, acute psychiatric providers to ensure compliance with the Contractor's requirements.  Provides training and technical assistance to Providers as required.  Provides necessary information to staff and alerts other agencies as necessary regarding Provider concerns.  Also provides orientation and ongoing technical assistance for new Providers.
  • Conducts and appropriately documents Provider retrospective reviews utilizing established UM guidelines, Medicaid Manual and/or BCF manual according to established time frames
  • Provides training and technical assistance to Providers and identifies training needs
  • Interfaces with staff regarding consultative reviews
  • Reports and analyzes data from reviews according to set timelines
  • Participates in monthly, quarterly and other required meetings

  • Associates degree in Nursing required
  • Active, clear WV RN license
  • Minimum 1-2 years' experience in direct practice with consumers
  • Demonstrated experience with MS 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
  • Ability to work independently to meet timelines and expectations
  • Ability to interact appropriately with providers under stressful and/or changing conditions

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 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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