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RN Reviewer - Healthcare in Scarborough, ME at KEPRO

Date Posted: 2/17/2018

Job Snapshot

Job Description

Currently recruiting for this office-based position in Scarborough, ME

RN Reviewer 

Utilization Management

  • Reviews and interprets patient records and compares against criteria to determine medical necessity and appropriateness of care; determines if the plan of care is followed in a timely manner and that the medical record documentation supports the delivery of quality care.  
  • Determines approval or referral to the physician consultant and processes physician consultant decisions. 
  • Abstracts review related data/information accurately and timely on appropriate review tool by the appropriate means. 
  • Ensures accurate and timely submission of all administrative and review related documents to appropriate parties. 
  • Monitors and complies with all Client and KEPRO requirements relative to accuracy and turnaround time for PARS.  Maintains production goals and QA standards.


  • Active non-restricted RN license required
  • 2years of clinical nursing required; Inpatient, Med/Surg strongly desired.
  • 2years’ experience with pre-authorization, utilization review/management, casemanagement, care coordination, and/or discharge planning
  • Experiencein services such as DME, Dental, Medical/Surgical, Psych, BH, Home Health etc.,strongly desired
  • Knowledgeof InterQual or Milliman criteria, CPT, and DRG codes required.
  • Solidcomputer skills (copy/cut/paste, maneuvering screens and typing) required.
  • Mustbe proficient with MS Office 
  • Excellentcommunication, organization & team building skills plus a strong focus oncustomer service & provider relations required. 
  • Abilityto maintain a positive attitude and contribute both as an individual and a teammember to achieve the goals of the department. 
  • Abilityto successfully respond to change and juggle multiple and changing prioritieswith sometimes conflicting deadlines. 

KEPRO offers challenging careers, excellentbenefits and opportunities for advancement.  For consideration, pleasesubmit resume and cover letter with salary requirements. Only thosecandidates identified for an interview will be contacted. No PhoneCalls Please.  Visit our website at for more informationon the KEPRO Family of Companies.  

EOE AAM/F/Vet/Disability

KEPROis an E-Verify employer. E-Verify is an internet based system operated by theDepartment of Homeland Security (DHS) in partnership with the Social SecurityAdministration (SSA) that allows participating employers to electronicallyverify the employment eligibility of their newly hired employees in the UnitedStates.


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